Sumida Hitoshi, Matsuzawa Yasushi, Sugiyama Seigo, Sugamura Koichi, Nozaki Toshimitsu, Akiyama Eiichi, Ohba Keisuke, Konishi Masaaki, Matsubara Junichi, Fujisue Koichiro, Maeda Hirofumi, Kurokawa Hirofumi, Iwashita Satomi, Ogawa Hisao, Tsujita Kenichi
Division of Emergency and General Medicine, Kumamoto Central Hospital, Kumamoto, Japan.
Division of Cardiovascular Medicine, Yokohama City University Medical Center, Yokohama, Japan.
J Cardiol. 2017 Nov;70(5):461-469. doi: 10.1016/j.jjcc.2017.03.004. Epub 2017 Apr 11.
Worsening renal function, indicated by increased serum creatinine (SCr), is a common complication of percutaneous coronary procedures. Risk factors for increased SCr overlap with coronary risk factors involved in endothelial dysfunction. We hypothesized that endothelial dysfunction, measured using the reactive hyperemia peripheral arterial tonometry index (RHI), can predict periprocedure-increased SCr.
RHI was assessed before elective coronary procedures in 316 consecutive stable patients with a preserved estimated glomerular filtration rate (eGFR, >60mL/min/1.73m). SCr was measured before and 2 days after procedures.
There was no significant correlation between natural logarithmic transformations of RHI (Ln-RHI) and basal Ln-eGFR. Periprocedure increase in SCr was observed in 148 (47%) patients. The increased SCr group had significantly lower Ln-RHI [0.48 (0.36, 0.62) vs. 0.59 (0.49, 0.76), p<0.001]. Multivariate linear regression analysis identified body mass index (BMI) (β=0.148, p=0.005) and Ln-RHI (β=-0.365, p<0.001) as significant determinants of percent changes in SCr. Multivariate logistic regression analysis identified Ln-RHI (per 0.1) [odds ratio (OR) 0.672, 95% confidence interval (95% CI) 0.586-0.722; p<0.001], Ln-B-type natriuretic peptide (OR: 1.484, 95% CI: 1.130-1.974; p=0.004), current smoking (OR: 2.563, 95% CI: 1.379-4.763, p=0.003), BMI (OR: 1.113, 95% CI: 1.031-1.203; p=0.007), coronary intervention (OR: 1.736, 95% CI: 1.036-2.909; p=0.036), and Ln-hemoglobin A1c (OR: 6.728, 95% CI: 1.093-41.392, p=0.040) as independent determinants of increased SCr. Receiver-operating characteristics curve analysis showed that Ln-RHI correlated significantly with increased SCr (area under the curve, 0.684, 95% CI: 0.626-0.742, p<0.001). The optimum cut-off point of Ln-RHI for the periprocedure increased SCr was 0.545.
Pre-procedure measurement of endothelial function by RHI is an effective strategy to assess the patient's risk conditions for worsening renal function after percutaneous coronary procedures.
血清肌酐（SCr）升高提示肾功能恶化，是经皮冠状动脉介入治疗的常见并发症。SCr升高的危险因素与内皮功能障碍相关的冠状动脉危险因素重叠。我们假设，使用反应性充血外周动脉张力测定指数（RHI）测量的内皮功能障碍可预测围手术期SCr升高。
对316例连续入选的估算肾小球滤过率（eGFR）保留（>60mL/min/1.73m²）的稳定患者，在择期冠状动脉介入治疗前评估RHI。在介入治疗前和治疗后2天测量SCr。
RHI的自然对数转换值（Ln-RHI）与基础Ln-eGFR之间无显著相关性。148例（47%）患者出现围手术期SCr升高。SCr升高组的Ln-RHI显著更低[0.48（0.36，0.62）对0.59（0.49，0.76），p<0.001]。多变量线性回归分析确定体重指数（BMI）（β=0.148，p=0.005）和Ln-RHI（β=-0.365，p<0.001）是SCr变化百分比的显著决定因素。多变量逻辑回归分析确定Ln-RHI（每0.1）[比值比（OR）0.672，95%置信区间（95%CI）0.586-0.722；p<0.001]、Ln-B型利钠肽（OR：1.484，95%CI：1.130-1.974；p=0.004）、当前吸烟（OR：2.563，95%CI：1.379-4.763，p=0.003）、BMI（OR：1.113，95%CI：1.031-1.203；p=0.007）、冠状动脉介入治疗（OR：1.736，95%CI：1.036-2.909；p=0.036）和Ln-糖化血红蛋白（OR：6.728，95%CI：1.093-41.392，p=0.040）是SCr升高的独立决定因素。受试者工作特征曲线分析显示，Ln-RHI与SCr升高显著相关（曲线下面积，0.684，95%CI：0.626-0.742，p<0.001）。围手术期SCr升高的Ln-RHI最佳截断点为0.545。
通过RHI术前测量内皮功能是评估经皮冠状动脉介入治疗后患者肾功能恶化风险状况的有效策略。
