低密度脂蛋白胆固醇作为接受经皮冠状动脉介入治疗患者发生对比剂诱导急性肾损伤的一种新的危险因素。
LDL cholesterol as a novel risk factor for contrast-induced acute kidney injury in patients undergoing percutaneous coronary intervention.
作者信息
Liu Yuan-hui, Liu Yong, Chen Ji-yan, Zhou Ying-ling, Chen Zhu-jun, Yu Dan-qing, Luo Jian-fang, Li Hua-long, He Yi-ting, Ye Piao, Ran Peng, Guo Wei, Tan Ning
机构信息
Southern Medical University, Guangzhou 510515, Guangdong, China; Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, Guangdong, China.
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, Guangdong, China.
出版信息
Atherosclerosis. 2014 Dec;237(2):453-9. doi: 10.1016/j.atherosclerosis.2014.10.022. Epub 2014 Oct 17.
BACKGROUND
Low density lipoprotein cholesterol (LDL-C) is associated with endothelial dysfunction, inflammation and increased vasoconstriction, which are involved in the development of contrast-induced acute kidney injury (CI-AKI). However, whether LDL-C is an independent risk factor of CI-AKI in patients undergoing percutaneous coronary intervention (PCI) is unknown.
METHODS
We prospectively enrolled 3236 consecutive patients undergoing PCI between January 2010 and September 2012. Multivariate logistic regression analysis was used to determine whether LDL-C is an independent risk factor of CI-AKI. CI-AKI was defined as an absolute increase in serum creatinine of ≥ 0.5 mg/dL or ≥ 25% over the baseline value within 48-72 h after contrast exposure.
RESULTS
CI-AKI was observed in 338 patients (10.4%). Patients with CI-AKI had a significantly higher rate of in hospital mortality (4.4% vs. 0.5%, p < 0.001), and significantly higher rates of other in hospital complications compared with those without CI-AKI. The LDL-C quartiles were as follows: Q1 (<2.04 mmol/L), Q2 (2.04-2.61 mmol/L), Q3 (2.61-3.21 mmol/L) and Q4 (>3.21 mmol/L). Patients with high baseline LDL-C levels were more likely to develop CI-AKI and composite end points including all-cause mortality, renal replacement therapy, non-fatal myocardial infarction, acute heart failure, target vessel revascularization or cerebrovascular accident during the observation period of hospitalization (8.9%, 9.9%, 10.5%, 12.6%, p = 0.001, and 5.0%, 5.2%, 6.1%, 8.1%, respectively; p = 0.007). Univariate logistic analysis showed that LDL-C levels (increment 1 mmol/L) were significantly associated with CI-AKI (odds ratio = 1.25, 95% confidence interval (CI), 1.11-1.39, p < 0.001). Furthermore, LDL-C remained a significant risk factor of CI-AKI (odds ratio = 1.23, 95% CI, 1.04-1.45, p = 0.014), even after adjusting for potential confounding risk factors.
CONCLUSIONS
Measurement of plasma LDL-C concentrations in patients undergoing PCI may be helpful to identify those who are at risk of CI-AKI and poor in hospital outcomes.
背景
低密度脂蛋白胆固醇（LDL-C）与内皮功能障碍、炎症及血管收缩增强有关，这些因素参与了造影剂诱导的急性肾损伤（CI-AKI）的发生发展。然而，LDL-C是否为接受经皮冠状动脉介入治疗（PCI）患者发生CI-AKI的独立危险因素尚不清楚。
方法
我们前瞻性纳入了2010年1月至2012年9月期间连续接受PCI的3236例患者。采用多因素逻辑回归分析来确定LDL-C是否为CI-AKI的独立危险因素。CI-AKI定义为造影剂暴露后48 - 72小时内血清肌酐较基线值绝对升高≥0.5mg/dL或≥25%。
结果
338例患者（10.4%）发生了CI-AKI。与未发生CI-AKI的患者相比，发生CI-AKI的患者住院死亡率显著更高（4.4%对0.5%，p<0.001），且其他住院并发症发生率也显著更高。LDL-C四分位数如下：Q1（<2.04mmol/L）、Q2（2.04 - 2.61mmol/L）、Q3（2.61 - 3.21mmol/L）和Q4（>3.21mmol/L）。基线LDL-C水平高的患者在住院观察期间更易发生CI-AKI及包括全因死亡率、肾脏替代治疗、非致命性心肌梗死、急性心力衰竭、靶血管血运重建或脑血管意外在内的复合终点事件（分别为8.9%、9.9%、10.5%、12.6%，p = 0.001；以及5.0%、5.2%、6.1%、8.1%，p = 0.007）。单因素逻辑分析显示，LDL-C水平（每增加1mmol/L）与CI-AKI显著相关（比值比 = 1.25，95%置信区间（CI）为1.11 - 1.39，p<0.001）。此外，即使在调整潜在的混杂危险因素后，LDL-C仍是CI-AKI的显著危险因素（比值比 = 1.23，95%CI为1.04 - 1.45，p = 0.014）。
结论
测定接受PCI患者的血浆LDL-C浓度可能有助于识别有发生CI-AKI风险及住院结局较差的患者。
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