【摘要】：目的：通過評估經(jīng)皮冠狀動脈介入術(shù)術(shù)前相關(guān)臨床指標(biāo),對造影劑致急性腎損傷(contrast-induced acute kidney injury,CI-AKI)的相關(guān)危險(xiǎn)因素進(jìn)行回顧性的分析,探討造影劑致急性腎損傷的危險(xiǎn)因素。 方法：選擇自2012年1月至2013年1月在武警后勤學(xué)院附屬醫(yī)院心血管內(nèi)科行PCI的患者425例為對象,收集患者的年齡、性別、高血壓、糖尿病、血脂、介入前后腎功能、造影劑用量等相關(guān)臨床指標(biāo)。同時(shí)排除腎移植者及腎功能衰竭需透析者、妊娠哺乳期、有含碘造影劑過敏史者、48小時(shí)內(nèi)使用過非甾體抗炎藥、1周內(nèi)使用過腎毒性藥物、4周內(nèi)接觸過造影劑患者等。根據(jù)CI-AKI的診斷標(biāo)準(zhǔn)將研究對象分為CI-AKI組和非CI-AKI組,來分析CI-AKI的發(fā)生率,用單因素分析和Logistic多因素回歸分析CI-AKI的危險(xiǎn)因素。 結(jié)果： 1.通過比較425例行PCI患者術(shù)前術(shù)后患者血清肌酐水平,確定113例為CI-AKI,發(fā)生率為26.6%。將患者分為CI-AKI組及非CI-AKI組,對比CI-AKI組與非CI-AKI組在年齡、高血壓、糖尿病、高脂血癥等指標(biāo),P0.05無統(tǒng)計(jì)學(xué)差異；但兩組性別、左心室射血分?jǐn)?shù)及慢性腎功能不全病史存在明確的統(tǒng)計(jì)學(xué)差異(P0.05)。 2.對比兩組造影劑,其中CI-AKI組為183.48±55.91ml,非CI-AKI組為190.00±60.45ml,無統(tǒng)計(jì)學(xué)差異(P0.05)。 3.logistic多因素回歸分析：男性、CRF病史、術(shù)前Scr即為排除混雜因素后與CI-AKI發(fā)病相關(guān)的獨(dú)立危險(xiǎn)因素,按相對危險(xiǎn)性由大到小依次為：男性(OR值5.111),CRF病史(OR值4.213),術(shù)前Scr(OR值2.995)。術(shù)前RBC(OR值0.084)、EF值(OR值0.939)為降低CI-AKI發(fā)病的保護(hù)因素。 結(jié)論： 慢性腎功能不全病史、男性、血清肌酐可能是造影劑致急性腎損傷的獨(dú)立危險(xiǎn)因素。術(shù)前RBC、EF值可能是造影劑致急性腎損傷的保護(hù)因素。
[Abstract]:Objective: to investigate the risk factors of acute renal injury induced by contrast agent (contrast-induced acute kidney injuryor CI-AKI) by evaluating the clinical parameters before percutaneous coronary intervention (PCI). Methods: from January 2012 to January 2013, 425 patients with PCI in Cardiovascular Department of affiliated Hospital of Armed Police Logistics College were selected as subjects. The patients' age, sex, hypertension, diabetes mellitus, blood lipid, renal function before and after intervention were collected. Contrast agent dosage and other related clinical indicators. At the same time, renal transplant recipients and renal failure patients needed dialysis, pregnancy and lactation, patients with history of iodine contrast agent allergy were treated with NSAIDs within 1 week and those who had been exposed to contrast agents within 4 weeks. According to the diagnostic criteria of CI-AKI, the subjects were divided into CI-AKI group and non-CI-AKI group to analyze the incidence of CI-AKI. Univariate analysis and Logistic multivariate regression analysis were used to analyze the risk factors of CI-AKI. Results: 1. By comparing the serum creatinine level of 425 patients with PCI before and after operation, 113 cases were confirmed as CI-AKI, the incidence rate was 26.6. The patients were divided into CI-AKI group and non-CI-AKI group. There was no significant difference in age, hypertension, diabetes mellitus, hyperlipidemia between CI-AKI group and non-CI-AKI group. Left ventricular ejection fraction and history of chronic renal insufficiency were significantly different (P0.05). The contrast medium was 183.48 鹵55.91 ml in CI-AKI group and 190.00 鹵60.45 ml in non-CI-AKI group (P0.05). There was no statistical difference between the two groups (P0.05). 3.logistic multivariate regression analysis showed that Scr was an independent risk factor associated with the onset of CI-AKI after exclusion of confounding factors. The order of relative risk was: male (OR 5.111), history of CRF (OR 4.213), preoperative Scr (OR (2.995). Preoperative RBC (OR value (0.084) and EF value (OR 0.939) were the protective factors to reduce the incidence of CI-AKI. Conclusion: the history of chronic renal insufficiency, male, serum creatinine may be an independent risk factor of acute renal injury induced by contrast agent. Preoperative RBCU EF may be a protective factor for acute renal injury induced by contrast agent.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R541.4;R692

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