择期行心脏导管插入术或经皮冠状动脉介入治疗的糖尿病患者对比剂肾病的预测：容量与肌酐清除率比值及碘剂量与肌酐清除率比值的作用

Prediction of contrast-induced nephropathy in diabetic patients undergoing elective cardiac catheterization or PCI: role of volume-to-creatinine clearance ratio and iodine dose-to-creatinine clearance ratio.

作者信息

Worasuwannarak Surapong, Pornratanarangsi Suwatchai

机构信息

Division of Cardiology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

出版信息

J Med Assoc Thai. 2010 Jan;93 Suppl 1:S29-34.

PMID:20364554

Abstract

OBJECTIVE

To assess a role of volume-to-creatinine clearance ratio (V/CrCl) and iodine dose-to-creatinine clearance ratio (I-dose/CrCl) in predicting contrast- induced nephropathy (CIN) in diabetic patients undergoing elective cardiac catheterization or percutaneous coronary intervention (PCI).

BACKGROUND

In diabetic patients undergoing cardiac catheterization or PCI, the incidence of CIN is higher than in non-diabetic patients. High doses of contrast media also increase the likelihood of renal dysfunction. The ratio of the volume of contrast media to creatinine clearance (V/CrCl) and iodine dose-to-creatinine clearance (I-dose/CrCl) has been shown to correlate with the area under the curve of contrast media concentration over time and was used to predict the occurrence of CIN in unselected patients. No study has been conducted specifically in diabetic patients undergoing cardiac catheterization or PCI before.

MATERIAL AND METHOD

We conducted a prospective, single center study. The V/CrCl and I-dose/CrCl were calculated in diabetic patients undergoing elective cardiac catheterization or PCI. An increase in serum creatinine of > 0.5 mg/dl or > 25% by 7 days from baseline was considered CIN. The incidence of CIN was determined. The predictive value of V/CrCl and I-dose/CrCl for CIN were assessed using multivariable logistic regression.

RESULTS

The total number of patients that had been enrolled in the study was 248; Male 50.8%. The overall incidence of CIN was 5.2%. The mean age for the entire population was 65 +/- 9 years; the mean body mass index was 25.6 +/- 4.0 kg/m2; and the mean creatinine clearance was 60.6 +/- 27.4 ml/min. The mean values of V/CrCl for patients with and without CIN were 3.7 +/- 2.9 and 2.2 +/- 1.7 (p = 0.041). The mean values of I-dose/CrCl for patients with and without CIN were 1.31 +/- 0.94 and 0.82 +/- 0.63 (p = 0.042). The receiver-operator characteristic curve analysis indicated that a V/CrCl ratio of 2.60 and I-dose/CrCl of 0.98 were fair predictors of CIN. After adjusting for other known predictors of CIN, a V/CrCl ratio > or = 2.60 remained the only significant predictor of CIN (Odds ratio 5.8; 95% confidence interval 1.7-19.4, p = 0.005).

CONCLUSIONS

A V/CrCl ratio > or = 2.60 was a significant predictor of CIN in diabetic patients undergoing elective cardiac catheterization or PCI.

摘要

目的

评估容积与肌酐清除率比值（V/CrCl）和碘剂量与肌酐清除率比值（I-dose/CrCl）在预测接受择期心导管插入术或经皮冠状动脉介入治疗（PCI）的糖尿病患者发生对比剂肾病（CIN）中的作用。

背景

在接受心导管插入术或PCI的糖尿病患者中，CIN的发生率高于非糖尿病患者。高剂量的造影剂也会增加肾功能不全的可能性。造影剂体积与肌酐清除率的比值（V/CrCl）以及碘剂量与肌酐清除率的比值（I-dose/CrCl）已被证明与造影剂浓度随时间变化的曲线下面积相关，并用于预测未选择患者中CIN的发生。此前尚未针对接受心导管插入术或PCI的糖尿病患者进行专门研究。

材料与方法

我们进行了一项前瞻性单中心研究。计算接受择期心导管插入术或PCI的糖尿病患者的V/CrCl和I-dose/CrCl。血清肌酐较基线水平在7天内升高>0.5mg/dl或>25%被视为CIN。确定CIN的发生率。使用多变量逻辑回归评估V/CrCl和I-dose/CrCl对CIN的预测价值。

结果

本研究共纳入患者248例；男性占50.8%。CIN的总体发生率为5.2%。整个人群的平均年龄为65±9岁；平均体重指数为25.6±4.0kg/m²；平均肌酐清除率为60.6±27.4ml/min。发生CIN和未发生CIN患者的V/CrCl平均值分别为3.7±2.9和2.2±1.7（p=0.041）。发生CIN和未发生CIN患者的I-dose/CrCl平均值分别为1.31±0.94和0.82±0.63（p=0.042）。受试者工作特征曲线分析表明，V/CrCl比值为2.60和I-dose/CrCl为0.98对CIN有较好的预测价值。在对其他已知的CIN预测因素进行校正后，V/CrCl比值≥2.60仍然是CIN的唯一显著预测因素（优势比5.8；95%置信区间1.7 - 19.4，p=0.005）。