Jabara Refat, Gadesam Radhika R, Pendyala Lakshmana K, Knopf William D, Chronos Nicolas, Chen Jack P, Viel Kevin, King Spencer B, Manoukian Steven V
Saint Joseph's Cardiovascular Research Institute/Saint Joseph's Hospital of Atlanta, Atlanta, Georgia, USA.
Am J Cardiol. 2009 Jun 15;103(12):1657-62. doi: 10.1016/j.amjcard.2009.02.039. Epub 2009 Apr 16.
Several definitions have been used to assess rates of contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary intervention (PCI). Whether the definition influences observed rates of CIN is unclear. The Oxilan Registry was the first-ever prospective analysis of the efficacy and safety of ioxilan (low-osmolar and low-viscosity contrast medium), including rates of CIN assessed by multiple definitions, in PCI. From July 2006 to June 2007, consecutive patients undergoing PCI using ioxilan were enrolled. Serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) were assessed at baseline and 3 to 5 days after PCI. CIN was defined as SCr increase >or=0.5 mg/dl, eGFR decrease >or=25%, SCr increase >or=25%, or the composite. Of 400 patients (age 62 +/- 11 years), 19% were women, 37% were diabetic, 22% were anemic, and 8% had a history of congestive heart failure. Baseline SCr was 1.12 +/- 0.3 mg/dl and 24% had an eGFR <60 ml/min. CIN rates were 3.3% (SCr increase >or=0.5 mg/dl), 7.6% (eGFR decrease >or=25%), 10.2% (SCr increase >or=25%), and 10.5% (composite). Hospitalization was prolonged in 3.4% of patients with CIN and none required dialysis. There were no deaths or severe allergic reactions. Non-ST-elevation myocardial infarction and repeat revascularization each occurred in 0.8%. In conclusion, in this unselected population undergoing PCI, CIN ranged in frequency from 3.3% to 10.5% depending on the definition used and was not associated with in-hospital mortality or substantial morbidity, such as dialysis. The wide variation in CIN and its lack of association with adverse outcomes underscore the need for a standardized, clinically relevant definition.
有几种定义被用于评估接受经皮冠状动脉介入治疗（PCI）患者的对比剂肾病（CIN）发生率。该定义是否会影响观察到的CIN发生率尚不清楚。Oxilan注册研究是对碘克沙醇（低渗和低粘度造影剂）在PCI中的疗效和安全性进行的首次前瞻性分析，包括通过多种定义评估的CIN发生率。从2006年7月至2007年6月，连续纳入使用碘克沙醇进行PCI的患者。在基线时以及PCI后3至5天评估血清肌酐（SCr）和估计肾小球滤过率（eGFR）。CIN的定义为SCr升高≥0.5mg/dl、eGFR降低≥25%、SCr升高≥25%或复合标准。在400例患者（年龄62±11岁）中，19%为女性，37%为糖尿病患者，22%为贫血患者，8%有充血性心力衰竭病史。基线SCr为1.12±0.3mg/dl，24%的患者eGFR<60ml/min。CIN发生率分别为3.3%（SCr升高≥0.5mg/dl）、7.6%（eGFR降低≥25%）、10.2%（SCr升高≥25%）和10.5%（复合标准）。3.4%的CIN患者住院时间延长，无人需要透析。无死亡或严重过敏反应发生。非ST段抬高型心肌梗死和再次血管重建的发生率均为0.8%。总之，在这个未经过筛选的接受PCI的人群中，根据所使用的定义，CIN发生率在3.3%至10.5%之间，且与院内死亡率或诸如透析等严重发病率无关。CIN的广泛差异及其与不良结局缺乏关联凸显了需要一个标准化的、临床相关的定义。
