本文選題：造影劑腎病 + 危險因素��； 參考：《浙江中醫(yī)藥大學》2017年碩士論文

【摘要】：目的 對造影劑腎病(contrast—media induced nephropathy,CIN)的相關(guān)危險因素及中醫(yī)證候要素進行分析探討,以便在檢測前或檢測過程中,盡可能的減少危險因素的出現(xiàn),或者在危險因素出現(xiàn)的早期盡可能進行干預(yù),利于改善預(yù)后、腎功能的恢復(fù)以及提高患者生存率等。方法 通過回顧性研究的調(diào)查方法,收集2016年1月至2016年12月采用優(yōu)維顯、歐乃派克和安射力進行造影檢查的住院患者共1424例,根據(jù)三種不同的造影劑比較其發(fā)病情況,并從中選取使用優(yōu)維顯進行檢查的患者478例進行具體研究分析。收集這478例患者的臨床資料,包括一般情況、實驗室指標、中醫(yī)證候、原發(fā)疾病診斷等,根據(jù)是否發(fā)生造影劑腎病分為CIN組(21例)與非CIN組(457例),比較兩組組內(nèi)組間差異,分析各項指標與造影劑腎病發(fā)生的相關(guān)性。結(jié)果 本研究中結(jié)果顯示,(1)三種不同的低滲造影劑對造影劑腎病發(fā)生的影響無明顯差異,其比例約為1:1:1。(2)通過對478例使用優(yōu)維顯的造影患者的研究分析發(fā)現(xiàn)CKD患者的發(fā)病率(23.8%)較非CKD患者(3.4%)明顯升高(P0.05)。(3)將CIN組與非CIN組的造影前肌酐進行比較,發(fā)現(xiàn)CIN組造影前肌酐明顯高于非CIN組(P0.05)。再將CIN患者進行組內(nèi)各項實驗室指標比較發(fā)現(xiàn),CIN引起的腎臟損傷短期內(nèi)主要表現(xiàn)為血肌酐、尿素明顯升高(P0.01),而對白蛋白、尿酸、血紅蛋白均無明顯影響(P0.05)。(4)將CIN組與非CIN組進行比較,研究顯示單純冠心病可影響CIN的發(fā)生(P0.05),高血壓合并糖尿病患者較無原發(fā)疾病患者及單純高血壓患者發(fā)病率均有顯著提高(P0.05),但單純高血壓患者或單純糖尿病患者CIN的發(fā)生率無明顯變化(P0.05)。通過二分類Logistic回歸分析,單純心臟病、高血壓合并心臟病都是影響CIN發(fā)生的危險因素(P0.05),OR值分別為4.066(95%CI 1.273,12.988)、3.888(95%CI 1.343,11.258)。(5)CIN組與非CIN組根據(jù)中醫(yī)證候要素進行分組比較后發(fā)現(xiàn)濕證與風證同時存在時較單獨存在發(fā)病率明顯升高,且瘀證比虛證的發(fā)病率高(P0.05)。結(jié)論 在本研究的478例患者中CIN的發(fā)生率約為4.4%,其中CKD患者的CIN發(fā)生率較非CKD患者明顯增加。在腎功能不全患者中血肌酐水平與CIN的發(fā)生存在相關(guān)性,CKD患者基礎(chǔ)肌酐越高,越容易出現(xiàn)CIN。造影劑引起的急性腎損傷主要體現(xiàn)為血肌酐、尿素短期內(nèi)明顯升高,對尿酸、血紅蛋白無明顯影響,因此可推測尿素亦可作為早期聯(lián)合判斷CIN發(fā)生的指標之一。單純冠心病、高血壓合并糖尿病是CIN發(fā)生的危險因素之一。高血壓合并糖尿病患者較無原發(fā)病患者及單純高血壓患者發(fā)病率均有顯著提高。濕證與風證同時存在時較單獨存在發(fā)病率明顯升高;瘀證比虛證發(fā)生CIN可能性更大。
[Abstract]:Objective to analyze the risk factors and syndromes of contrast-media induced nephropathy (cin) in order to minimize the occurrence of risk factors before or during detection. Or intervention as early as possible in the early stages of risk factors can improve prognosis, renal function and survival rate. Methods from January 2016 to December 2016, a total of 1424 inpatients who had been examined by Uvexin, Onaipek and Anemone from January 2016 to December 2016 were collected and compared according to three different contrast agents. 478 patients who were examined with UVX were studied and analyzed. The clinical data of 478 patients were collected, including general conditions, laboratory indicators, TCM syndromes, diagnosis of primary diseases and so on. According to whether contrast agent nephropathy occurred or not, they were divided into cin group (21 cases) and non-cin group (457 cases). The differences between the two groups were compared. To analyze the correlation between various indexes and the occurrence of contrast agent nephropathy. Results the results of this study showed that (1) there was no significant difference in the effect of three different hypotonic contrast agents on the occurrence of contrast agent nephropathy. The ratio was about 1: 1: 1. (2) A study of 478 patients with urography showed that the incidence of). (was significantly higher than that of non-CKD patients (P0.05). (3). It was found that the level of creatinine in cin group was significantly higher than that in non-cin group (P 0.05). By comparing the laboratory indexes of cin patients in the group, we found that the main manifestations of renal injury caused by cin in a short period of time were serum creatinine and urea (P0.01), but in the treatment of albumin, uric acid, serum creatinine and urea were significantly increased (P0.01). There was no significant difference in hemoglobin (P0.05). (4) between cin group and non-cin group. The results showed that the incidence of cin was affected by coronary heart disease alone (P0.05). The incidence of cin in hypertensive patients with diabetes was significantly higher than that in patients without primary diseases and patients with hypertension (P0.05), but the incidence of cin in patients with hypertension or diabetes mellitus was significantly higher than that in patients with diabetes mellitus (P < 0.05). There was no significant change in the incidence rate (P0.05). By two classification logistic regression analysis, simple heart disease, Hypertension and heart disease were the risk factors of cin (P 0.05). The OR values were 4.066 (95 CI 1.273 ~ 12.988) and 3.888 (95 CI 1.343 ~ 11.258). (5). The incidence of wet syndrome and wind syndrome were significantly higher in cin group than in non-cin group according to TCM syndromes. The incidence of stasis syndrome was higher than that of deficiency syndrome (P0.05). Conclusion the incidence of cin was about 4.4 in 478 patients in this study. The incidence of cin in CKD patients was significantly higher than that in non-CKD patients. There is a correlation between serum creatinine level and the occurrence of cin in patients with renal insufficiency. The higher the level of basal creatinine in CKD patients is, the more likely it is to have CINs. Acute renal injury caused by contrast agent was mainly manifested as blood creatinine, urea increased obviously in the short term, but had no obvious effect on uric acid and hemoglobin. Therefore, it can be speculated that urea can also be used as one of the early indicators to judge the occurrence of cin. Coronary heart disease alone, hypertension with diabetes mellitus is one of the risk factors of cin. The incidence of hypertension complicated with diabetes was significantly higher than that of patients without primary disease and simple hypertension. The morbidity of dampness syndrome and wind syndrome was significantly higher than that of single syndrome, and the incidence of cin was more likely to occur in blood stasis syndrome than that in deficiency syndrome.
【學位授予單位】：浙江中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R277.5

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