分析接受冠状动脉介入治疗的超龄患者对比剂肾病的危险因素。
Analysis of the risk factors for contrast-induced nephropathy in over-aged patients receiving coronary intervention.
机构信息
Department of Cardiology, Shanghai Tong Ren Hospital, Shanghai 200336, China.
出版信息
Exp Biol Med (Maywood). 2018 Aug;243(12):970-975. doi: 10.1177/1535370218799973.
Contrast-induced nephropathy has been the common cause of hospital-acquired acute kidney injury in the elderly patients. This study aimed to analyze the risk factors for contrast-induced nephropathy in over-aged patients undergoing coronary angiography or percutaneous coronary intervention. A total of 470 over-aged patients (≥80 years old) were judged as the contrast-induced nephropathy group ( n = 46) and non-contrast-induced nephropathy group ( n = 424) according to the postoperative 48-h serum creatinine levels. The patients' clinical information such as hypertension grade, number and degree of coronary artery stenosis, and death rate was compared. The risk factors for contrast-induced nephropathy were also analyzed. The hypertension grade in the contrast-induced nephropathy group was significantly higher than that in the non-contrast-induced nephropathy group ( P = 0.004). The degree of coronary artery stenosis was significantly more in the contrast-induced nephropathy group compared with the non-contrast-induced nephropathy group ( P = 0.003). The death rate of the contrast-induced nephropathy group (15.8%) was significantly higher than that of the non-contrast-induced nephropathy group (0.6%; P = 0.000). The percentage of patients with abnormal urine microalbumin was significantly bigger in the contrast-induced nephropathy group (62.5%) when comparing to the non-contrast-induced nephropathy group (23.6%; P = 0.00). Besides, there was also significant difference in the emergency/selective operation between the contrast-induced nephropathy group and non-contrast-induced nephropathy group ( P = 0.001). Further, hypertension grade ( P = 0.019), emergency/selective operation ( P = 0.025), degree of coronary artery stenosis ( P = 0.038), eGFR ( P = 0.034), and urine microalbumin ( P = 0.005) were the risk factors for contrast-induced nephropathy. Hypertension grade, emergency/selective operation, degree of coronary artery stenosis, eGFR, and urine microalbumin were the risk factors for contrast-induced nephropathy in over-aged patients receiving coronary angiography and percutaneous coronary intervention, providing guidance for the clinical prevention of contrast-induced nephropathy. Impact statement In this work, we evaluated the risk factors for contrast-induced nephropathy (CIN) in over-aged patients receiving coronary angiography (CAG) and percutaneous coronary intervention (PCI). We found that hypertension grade, emergency/selective operation, degree of coronary artery stenosis, eGFR, and urine microalbumin were the risk factors for CIN in over-aged patients receiving CAG and PCI. This study provides guidance for the clinical prevention of CIN in over-aged patients undergoing coronary intervention, highlighting that a perioperative comprehensive management strategy is needed to improve the prognosis.
对比剂肾病已成为老年患者医院获得性急性肾损伤的常见原因。本研究旨在分析冠状动脉造影或经皮冠状动脉介入治疗中超龄患者发生对比剂肾病的危险因素。根据术后 48 小时血清肌酐水平，将 470 名超龄患者（≥80 岁）判断为对比剂肾病组（n=46）和非对比剂肾病组（n=424）。比较患者的临床资料，如高血压分级、冠状动脉狭窄程度和程度、数量和死亡率。还分析了对比剂肾病的危险因素。对比剂肾病组的高血压分级明显高于非对比剂肾病组（P=0.004）。对比剂肾病组的冠状动脉狭窄程度明显大于非对比剂肾病组（P=0.003）。对比剂肾病组的死亡率（15.8%）明显高于非对比剂肾病组（0.6%；P=0.000）。对比剂肾病组（62.5%）异常尿微量白蛋白的患者比例明显大于非对比剂肾病组（23.6%；P=0.00）。此外，在对比剂肾病组和非对比剂肾病组之间，急诊/选择性手术之间也存在显著差异（P=0.001）。此外，高血压分级（P=0.019）、急诊/选择性手术（P=0.025）、冠状动脉狭窄程度（P=0.038）、eGFR（P=0.034）和尿微量白蛋白（P=0.005）是对比剂肾病的危险因素。高血压分级、急诊/选择性手术、冠状动脉狭窄程度、eGFR 和尿微量白蛋白是接受冠状动脉造影和经皮冠状动脉介入治疗的超龄患者发生对比剂肾病的危险因素，为临床预防对比剂肾病提供了指导。 影响声明 在这项工作中，我们评估了接受冠状动脉造影（CAG）和经皮冠状动脉介入治疗（PCI）的超龄患者发生对比剂肾病（CIN）的危险因素。我们发现，高血压分级、急诊/选择性手术、冠状动脉狭窄程度、eGFR 和尿微量白蛋白是接受 CAG 和 PCI 的超龄患者发生 CIN 的危险因素。这项研究为接受冠状动脉介入治疗的超龄患者的 CIN 临床预防提供了指导，强调需要综合管理策略来改善预后。
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