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目的探讨对比剂肾病(contrast-induced nephropathy,CIN)在非选择性患者中的发病率及其危险因素,以及等渗对比剂碘克沙醇的肾安全性。方法共入选532例接受冠状动脉介入诊疗术的患者,测定患者术前1周内任一天及术后48h的肾功能。以术后48h血肌酐(serum creatinine,SCr)较术前升高25%或升高44.2μmol/L(0.5mg/dL)为CIN的诊断标准,分析对比剂对肾功能的影响。用Logistic多因素回归分析CIN发生的危险因素。结果(1)532例患者中29例发生CIN,发病率为5.5%;(2)术前估计肾小球滤过率(estimate glomerular filtration rate,eGFR)<45mL/min的患者CIN发病率显著高于eGFR≥45mL/min的患者(17.5%比4.5%,P=0.002);(3)532例患者中,427例使用低渗对比剂,105例使用等渗对比剂碘克沙醇,低渗对比剂组术前平均eGFR显著高于等渗对比剂组(81.4±27.6mL/min比62.5±22.8mL/min,P=0.000),两者CIN发病率差异无统计学意义(5.6%比4.8%,P=0.797);(4)Logistic多因素分析显示,术前使用利尿剂、术前eGFR<45mL/min、对比剂用量≥500mL是CIN的独立危险因素。结论冠状动脉介入诊疗术后CIN在非选择性患者中的发病率为5.5%。在术前eGFR<45mL/min的患者中CIN的发病率显著升高。等渗对比剂碘克沙醇对肾的安全性可能略优于低渗对比剂。术前使用利尿剂、术前eGFR<45mL/min、对比剂用量≥500mL是CIN的独立危险因素。
Objective To investigate the incidence and risk factors of contrast-induced nephropathy (CIN) in nonselective patients and the renal safety of isotonic contrast agent iodixanol. METHODS: A total of 532 patients undergoing coronary intervention were enrolled in this study. Renal function was measured at any time within one week and 48h after surgery. The effect of contrast agent on renal function was analyzed with the diagnostic value of serum creatinine (SCr) increased by 25% or increased by 44.2 μmol / L (0.5 mg / dL) 48 h after operation. Logistic regression analysis was used to analyze the risk factors of CIN. Results (1) CIN was found in 29 out of 532 patients and the incidence was 5.5%. (2) The incidence of CIN was significantly higher in patients with preoperative estimated glomerular filtration rate (eGFR) <45 mL / min (17.5% vs 4.5%, P = 0.002) in patients with eGFR ≥45 mL / min; (3) Of the 532 patients, 427 received hypotonic contrast agent and 105 received isotonic contrast agent iodixanol, The preoperative mean eGFR of the contrast group was significantly higher than that of the isotonic contrast group (81.4 ± 27.6 mL / min vs. 62.5 ± 22.8 mL / min, P = 0.000). There was no significant difference in the incidence of CIN between the two groups (5.6% vs 4.8 %, P = 0.797). (4) Logistic multivariate analysis showed that preoperative eGFR <45mL / min and contrast agent≥500mL were independent risk factors for CIN. Conclusion The incidence of CIN in non-selective patients after coronary intervention was 5.5%. The incidence of CIN was significantly higher in patients with preoperative eGFR <45 mL / min. Isotonic Contraceptives Iodixanol may be slightly more safe on the kidney than hypotonic contrast agents. Preoperative use of diuretics, preoperative eGFR <45mL / min, the amount of contrast agent ≥ 500mL is an independent risk factor for CIN.