Cui Tongtao, Zhao Jianbin, Bei Weijie, Li Hualong, Tan Ning, Wu Dengxuan, Wang Kun, Guo Xiaosheng, Liu Yuanhui, Duan Chongyang, Chen Shiqun, Lin Kaiyang, Liu Yong
Guangdong General Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong provincial Key Laboratory of Coronary Disease, School of Medicine, South China University of Technology.
Cardiol J. 2017;24(6):660-670. doi: 10.5603/CJ.a2017.0048. Epub 2017 Apr 10.
Intravenous hydration during percutaneous coronary intervention (PCI) significantly reduces the risk of contrast-induced nephropathy (CIN), but there are no well-defined protocols regard¬ing the optimal hydration volume (HV) required to prevent CIN following emergent PCI. Therefore, this study investigates the association between the intravenous HV and CIN after emergent PCI.
711 patients were prospectively recruited who had underwent emergent PCI with hydration at routine speed and the relationship was investigated between HV or HV to weight ratio (HV/W) and the CIN risk, which was defined as a ≥ 25% or ≥ 0.5 mg/dL increase in serum creatinine levels from baseline within 48-72 h of exposure to the contrast.
The overall CIN incidence was 24.7%. Patients in the higher HV quartiles had elevated CIN rates. Multivariate analysis showed that higher HV/W ratios were not associated with a decreased risk (using the HV) of CIN, but they were associated with an increased risk (using the HV/W) of CIN (Q4 vs. Q1: adjusted odds ratio 1.99; 95% confidence interval 1.05-3.74; p = 0.034). A higher HV/W ratio was not significantly associated with a reduced risk of long-term death (all p > 0.05).
The data suggests that a higher total HV is not associated with a decreased CIN risk or beneficial long-term prognoses, and that excessive HV may increase the risk of CIN after emergent PCI.
经皮冠状动脉介入治疗（PCI）期间静脉补液可显著降低造影剂肾病（CIN）的风险，但对于急诊PCI后预防CIN所需的最佳补液量（HV）尚无明确的方案。因此，本研究探讨了急诊PCI后静脉补液量与CIN之间的关联。
前瞻性招募了711例行急诊PCI并按常规速度补液的患者，研究补液量或补液量与体重比（HV/W）和CIN风险之间的关系，CIN风险定义为在接触造影剂后48 - 72小时内血清肌酐水平较基线升高≥25%或≥0.5mg/dL。
CIN总体发生率为24.7%。较高四分位数补液量组的患者CIN发生率升高。多因素分析显示，较高的HV/W比值与CIN风险降低（以补液量计）无关，但与CIN风险增加（以HV/W计）有关（Q4与Q1相比：调整后的优势比为1.99；95%置信区间为1.05 - 3.74；p = 0.034）。较高的HV/W比值与长期死亡风险降低无显著关联（所有p>0.05）。
数据表明，较高的总补液量与CIN风险降低或长期有益预后无关，且过量补液可能增加急诊PCI后CIN的风险。
