口服补液对初次经皮冠状动脉介入治疗后患者对比剂诱导急性肾损伤的影响。
Effect of Oral Hydration on Contrast-Induced Acute Kidney Injury among Patients after Primary Percutaneous Coronary Intervention.
机构信息
Department of Scientific Research, Guangdong Province Hospital of Integrated Traditional Chinese and Western Medicine, Foshan, China,
Affiliated Guangdong Hospital of Integrated Traditional Chinese and Western Medicine of Guangzhou University of Chinese Medicine, Foshan, China.
出版信息
Cardiorenal Med. 2021;11(5-6):243-251. doi: 10.1159/000520088. Epub 2021 Nov 25.
OBJECTIVES
The purpose of this study was to evaluate the protective effect of oral hydration volume to weight ratio (OHV/W) on contrast-induced acute kidney injury (CI-AKI) among patients with ST-elevation myocardial infarction (STEMI) following percutaneous coronary intervention (PCI).
METHODS
A total of 754 patients with STEMI undergoing PCI were selected. Each patient was encouraged to drink as much water as possible 24 h after PCI. Total volume intake was recorded for all patients. The ratio of OHV/W was calculated. The occurrence of CI-AKI was defined as ≥0.5 mg/dL absolute or ≥25% relative increase in serum creatinine within 48-72 h following PCI. Logistic regression analysis and generalized additive model were performed to evaluate the relationship between OHV/W and CI-AKI.
RESULTS
There was a nonlinear relationship between OHV/W and CI-AKI with an inflection point of 15.69 mL/kg. On the right side of the inflection point (OHV/W ≥15.69 mL/kg), a negative relationship was detected between OHV/W and CI-AKI (HR = 0.90, 95% CI: 0.82∼0.98, p = 0.0126). However, no relationship was observed between OHV/W and CI-AKI on the left of inflection point (HR = 1.19, 95% CI: 0.95∼1.49, p = 0.1302). Subgroup analysis showed that significant interactions were observed only for gender difference (p for interaction = 0.0155), male patients had a significantly lower risk of CI-AKI (HR = 0.84, 95% CI: 0.75∼0.93, p = 0.0012).
CONCLUSION
OHV/W ≥15.6 mL/kg for 24 h post-procedure may be an effective preventive strategy of CI-AKI. In addition, male patients may particularly benefit from OHV to prevent CI-AKI.
目的
本研究旨在评估经皮冠状动脉介入治疗（PCI）后，患者的口服水化容量与体重比（OHV/W）对 ST 段抬高型心肌梗死（STEMI）患者对比剂诱导的急性肾损伤（CI-AKI）的保护作用。
方法
选取 754 例行 PCI 的 STEMI 患者。所有患者均在 PCI 后 24 h 内鼓励尽可能多喝水，记录总饮水量。计算 OHV/W 比值。CI-AKI 的发生定义为 PCI 后 48-72 h 内血清肌酐绝对升高≥0.5mg/dL 或相对升高≥25%。采用 logistic 回归分析和广义加性模型评估 OHV/W 与 CI-AKI 之间的关系。
结果
OHV/W 与 CI-AKI 之间存在非线性关系，拐点为 15.69 mL/kg。在拐点右侧（OHV/W≥15.69 mL/kg），OHV/W 与 CI-AKI 呈负相关（HR=0.90，95%CI：0.82∼0.98，p=0.0126）。然而，在拐点左侧（OHV/W＜15.69 mL/kg），OHV/W 与 CI-AKI 之间无相关性（HR=1.19，95%CI：0.95∼1.49，p=0.1302）。亚组分析显示，仅性别差异存在显著交互作用（p 交互=0.0155），男性患者发生 CI-AKI 的风险显著降低（HR=0.84，95%CI：0.75∼0.93，p=0.0012）。
结论
术后 24 h 内 OHV/W≥15.6 mL/kg 可能是预防 CI-AKI 的有效策略。此外，男性患者可能特别受益于 OHV 以预防 CI-AKI。
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