本文選題：慢性完全性閉塞病變 + 造影劑腎病��； 參考：《南方醫(yī)科大學(xué)》2015年碩士論文

【摘要】：研究背景：近些年來,隨著材料工程的發(fā)展和進步,大大加速了心導(dǎo)管術(shù)在心血管疾病的診療中的運用,由于心導(dǎo)管術(shù)應(yīng)用的增加,患者接觸造影劑頻率及用量均有所增加,因此導(dǎo)致腎臟損害的情況也逐步增加�，F(xiàn)有研究表明,醫(yī)院內(nèi)獲得性腎功能損害中,造影劑導(dǎo)致的腎臟損害可約達11%[1-4]。目前造影劑腎病(Contrast-Induced Nephropathy, CIN)已成為院內(nèi)獲得性腎功能障礙的三大主要病因之一,盡管造影劑導(dǎo)致的腎功能損害為一過性的病理生理過程,但也可能延長患者臨床病程以及導(dǎo)致臨床病情復(fù)雜化,甚至成為誘因?qū)е履I功能損害由一過性發(fā)展至永久性腎功能損害以至于需要長期腎臟替代治療。既往研究統(tǒng)計發(fā)現(xiàn),造影劑腎病的發(fā)生率大約在7%-15%[5],在不同人群中造影劑腎病的發(fā)生率差異較大。目的：探索慢性完全性閉塞病變(CTO)患者行冠脈造影術(shù)后造影劑腎病發(fā)生的危險因素研究人群：入選2010年5月至2013年6月于廣東省人民醫(yī)院行冠脈介入治療的CTO患者共300例。入選標準：年齡18歲,慢性完全性閉塞病變患者。排除標準：(1)需長期行腎臟替代治療或曾行腎移植；(2)PCI前2周內(nèi)有造影劑接觸史；(3)需行外科手術(shù)實現(xiàn)血運重建；(4)PCI圍手術(shù)期需使用二甲雙胍非甾體類抗炎藥、氨基糖類抗生素、乙酰半胱氨酸等影響腎功能藥物。研究方法：所有患者行PCI前及術(shù)后連續(xù)3天檢測血漿肌酐水平,收集患者實驗室及臨床事件等基線資料。所有患者使用造影劑后均按照指南給予適當水化。造影劑腎病定義為使用造影劑后48-72小時血清肌酐值比基線值升高超過44.2umol/l或25%。根據(jù)患者是否發(fā)生CIN分為2組：CIN組與非CIN組,比較組間基線資料、CIN發(fā)生率及院內(nèi)臨床事件的發(fā)生率。采用回歸分析校正各危險因素與CIN風(fēng)險的相關(guān)性。研究結(jié)果：300例CTO患者中男性共251(83.7%)；平均eGFR為65±23ml/min; 216 (72.0%)名患者有糖尿病病史：35(11.7%)例發(fā)生CIN；院內(nèi)死亡病例為3(1%),3例死亡病例均為發(fā)生CIN患者。CIN組與非CIN組間高血壓病史[16(45.7) vs 98(37.0) P=0.317]、2型糖尿病[22(62.9)vs194(73.2),P=0.200]、男性比例[31(88.6)vs 220(83.0),P=0.404]、高脂血癥比例[31(88.6)vs 228(86.0),P=0.682]差異均無統(tǒng)計學(xué)意義；CIN組患者基線估算腎小球濾過率(eGFR)及血漿白蛋白(30.9±6.3 vs 34.8±3.9,P=0.001)顯著低于非CIN組(83.39±44.00 vs 76.33±22.41,P0.001)。而年齡75歲比例[7(29.0)vs54(18.6),P=0.008]、(LVEF)45%[7(29.0) vs 60(21.9),P=0.015]、貧血[16(45.7)vs62(23.6),P=0.005]患者比例在CIN組顯著高于非CIN組(P值均0.05)。研究發(fā)現(xiàn)3例死亡病例,2例需行腎臟替代治療病例均為CIN組患者；且CIN組需植入IABP顯著高于非CIN組[4(11.4)vs 7(2.6),P=0.009]。多因素logistic回歸分析發(fā)現(xiàn)年齡75歲(OR=1.288, CI:1.032-1.608, P=0.025)、 LVEF45% (OR=2.941, CI:1.334-6.483, P=0.007)、eGFR (OR=1.017, CI:1.003-1.030, P=0.016)與CIN發(fā)生率顯著相關(guān)。結(jié)論：1.行冠脈介入診治的CTO患者中,年齡75歲、LVEF45%、腎功能不全為CIN發(fā)生的危險因素。2.CIN發(fā)生與院內(nèi)不良事件顯著相關(guān)。
[Abstract]:Background: in recent years, with the development and progress of material engineering, the application of cardiac catheterization in the diagnosis and treatment of cardiovascular diseases has been greatly accelerated. Due to the increase in the application of cardiac catheterization, the frequency and amount of exposure to contrast agents have increased. Therefore, the condition of kidney damage is gradually increased. In the impairment of the renal function, the renal damage caused by contrast agent can be reduced to 11%[1-4]. current contrast agent nephropathy (Contrast-Induced Nephropathy, CIN), which has become one of the three major causes of hospital acquired renal dysfunction, although the renal impairment caused by contrast agent is an excessive pathophysiological process, but it may also prolong the patient's clinical practice. The course of the disease, the complication of the clinical condition, and even the cause of the cause of the renal function damage from one to permanent renal impairment so that long-term renal replacement therapy is required. Previous studies have found that the incidence of contrast nephropathy is about 7%-15%[5], and the incidence of contrast nephropathy in different groups is different. Study on the risk factors for patients with chronic complete occlusive disease (CTO) after coronary angiography: 300 patients with CTO from May 2010 to June 2013 were enrolled in the coronary intervention treatment in Guangdong General Hospital. The criteria were: age 18, patients with slow complete occlusive disease. Exclusion criteria: (1) Long term renal replacement therapy or renal transplantation; (2) the history of contrast media exposure in the first 2 weeks of PCI; (3) the need for surgical operation to achieve revascularization; (4) the use of metformin nonsteroidal anti-inflammatory drugs, aminoglycan antibiotics, acetylcysteine and other renal functional drugs in the perioperative period of PCI. Study methods: all patients were performed before and after PCI Serum creatinine levels were measured for 3 days after 3 days, and baseline data of laboratory and clinical events were collected. All patients were given appropriate hydration after the use of contrast agents. Contrast agent nephropathy was defined as an increase in serum creatinine value of more than 44.2umol/l or 25%. at 48-72 hours after the use of contrast agents. CIN was divided into 2 according to whether the patients were divided into 2. Group CIN and non CIN group, compared with the baseline data, the incidence of CIN and the incidence of clinical events in the hospital. Regression analysis was used to correct the correlation between the risk factors and the risk of CIN. The results of the study were: 300 cases of CTO patients were 251 (83.7%); the average eGFR was 65 + 23ml/min; 216 (72%) patients had the history of diabetes: 35 (11.7%) cases. CIN was 3 (1%), and 3 cases of death were all [16 (45.7) vs 98 (37) P=0.317] in group.CIN and non CIN group, [22 (62.9) vs194 (73.2), P=0.200], [31 (88.6) vs 220 (83) in type 2 diabetes, and there was no statistical difference in the proportion of hyperlipidemia (88.6). The estimated glomerular filtration rate (eGFR) and plasma albumin (30.9 + 6.3 vs 34.8 + 3.9, P=0.001) in group CIN were significantly lower than those in non CIN group (83.39 + 44 vs 76.33 + 22.41, P0.001). The ratio of age 75 to [7 (29) vs54 (18.6), P=0.008], LVEF 45%[7 (29) The CIN group was significantly higher than the non CIN group (P value was 0.05). The study found that 3 cases of death and 2 cases of renal replacement therapy were all in group CIN, and CIN group needed to implant IABP significantly higher than non CIN group [4 (11.4) vs 7 (2.6), P=0.009]. multiple factor Logistic regression analysis found age 75 years old 1.334-6.483, P=0.007), eGFR (OR=1.017, CI:1.003-1.030, P=0.016) had a significant correlation with the incidence of CIN. Conclusion: among CTO patients with 1. lines of coronary intervention, the risk factors for CIN are 75 years old, LVEF45%, and renal insufficiency is significantly associated with adverse events in the hospital.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R543.3

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