Division of Cardiology, Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea.
Korean Circ J. 2010 Feb;40(2):68-73. doi: 10.4070/kcj.2010.40.2.68. Epub 2010 Feb 23.
The development of contrast-induced nephropathy (CIN) is associated with an increased risk of death and late cardiovascular events after percutaneous coronary intervention (PCI). The relationship between CIN and hemoglobin drop has been controversial. The aim of this study was to evaluate the clinical usefulness of periprocedural hemoglobin drop as a nontraditional risk factor for CIN.
Five-hundred thirty-seven patients who underwent PCI were divided into 2 groups: Group I (486 patients: patients who did not develop CIN) and Group II (51 patients: patients who developed CIN). All patients were administered iodixanol as contrast media during coronary angiography. CIN is defined as a rise in serum creatinine of >/=25% or >/=0.5 mg/dL above the baseline value within 48 hours after contrast administration.
BASELINE CLINICAL AND CARDIOVASCULAR RISK FACTORS WERE NOT SIGNIFICANTLY DIFFERENT BETWEEN THE TWO GROUPS, EXCEPT FOR LOW ABDOMINAL CIRCUMFERENCE (GROUP I : Group II=87.9+/-9.0 cm : 81.2+/-15.1 cm, p=0.024), body weight (Group I : Group II=63.5+/-10.6 kg : 59.7+/-9.2 kg, p=0.008), body mass index (BMI) (Group I : Group II=24.4+/-3.4 kg/m(2) : 23.4+/-2.8 kg/m(2), p=0.032), pre-PCI hemoglobin (Group I : Group II=13.2+/-2.0 g/dL : 12.3+/-2.0 g/dL, p=0.003), and post-PCI hemoglobin (Group I : Group II=12.4+/-1.9 g/dL : 11.5+/-1.8 g/dL, p=0.001). Multiple logistic regression analysis showed that a periprocedural drop in hemoglobin (>1 g/dL) was an independent predictor of CIN, like other known risk factors.
A periprocedural drop in hemoglobin of more than 1 g/dL is another important independent predictor for CIN, even in patients administered the lowest nephrotoxic contrast agent, iodixanol, during PCI.
对比剂诱导的肾病（CIN）的发展与经皮冠状动脉介入治疗（PCI）后死亡和晚期心血管事件的风险增加有关。CIN 与血红蛋白下降之间的关系一直存在争议。本研究的目的是评估围手术期血红蛋白下降作为 CIN 的非传统危险因素的临床意义。
537 例接受 PCI 的患者分为 2 组：I 组（486 例：未发生 CIN 的患者）和 II 组（51 例：发生 CIN 的患者）。所有患者在冠状动脉造影时均给予碘克沙醇作为对比剂。CIN 定义为造影后 48 小时内血清肌酐升高>/=25%或>/=0.5mg/dL 以上基线值。
两组患者的基线临床和心血管危险因素无显著差异，除了低腹围（I 组：II 组=87.9+/-9.0cm：81.2+/-15.1cm，p=0.024）、体重（I 组：II 组=63.5+/-10.6kg：59.7+/-9.2kg，p=0.008）、体重指数（BMI）（I 组：II 组=24.4+/-3.4kg/m2：23.4+/-2.8kg/m2，p=0.032）、术前血红蛋白（I 组：II 组=13.2+/-2.0g/dL：12.3+/-2.0g/dL，p=0.003）和术后血红蛋白（I 组：II 组=12.4+/-1.9g/dL：11.5+/-1.8g/dL，p=0.001）。多因素 logistic 回归分析显示，围手术期血红蛋白下降（>1g/dL）是 CIN 的独立预测因素，与其他已知危险因素一样。
在接受 PCI 治疗的患者中，即使使用最低肾毒性对比剂碘克沙醇，血红蛋白下降>1g/dL 也是 CIN 的另一个重要独立预测因素。
