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中华诊断学电子杂志 ›› 2014, Vol. 02 ›› Issue (04) : 279 -284. doi: 10.3877/cma.j.issn.2095-655X.2014.04.009

所属专题: 文献

临床研究

造影剂剂量与估计肾小球滤过率比值对高龄糖尿病患者造影剂肾病的诊断价值
刘雷1, 石莉1,(), 张宜明1, 王彦富2, 李新建1, 李清贤2   
  1. 1. 272029 济宁医学院附属医院肾内科
    2. 272029 济宁医学院附属医院心内科
  • 收稿日期:2014-06-15 出版日期:2014-11-26
  • 通信作者: 石莉
  • 基金资助:
    山东省医药卫生科技发展计划项目(2011BJYB20)

The diagnostic value of the ratio of contrast medium volume to estimated glomerular filtration rate in contrast-induced nephropathy diabetics patients

Lei Liu1, Li Shi1,(), Yiming Zhang1, Yanfu Wang2, Xinjian Li1, Qingxian Li2   

  1. 1. Department of Nephrology, Affiliated Hospital of Jining Medical College, Jining 272029, China
  • Received:2014-06-15 Published:2014-11-26
  • Corresponding author: Li Shi
  • About author:
    Corresponding author: Shi Li, Email:
引用本文:

刘雷, 石莉, 张宜明, 王彦富, 李新建, 李清贤. 造影剂剂量与估计肾小球滤过率比值对高龄糖尿病患者造影剂肾病的诊断价值[J]. 中华诊断学电子杂志, 2014, 02(04): 279-284.

Lei Liu, Li Shi, Yiming Zhang, Yanfu Wang, Xinjian Li, Qingxian Li. The diagnostic value of the ratio of contrast medium volume to estimated glomerular filtration rate in contrast-induced nephropathy diabetics patients[J]. Chinese Journal of Diagnostics(Electronic Edition), 2014, 02(04): 279-284.

目的

探讨经皮冠状动脉介入治疗(PCI)术后造影剂肾病(CIN)的发病情况;评估造影剂剂量(CMV)与估计肾小球滤过率(eGFR)比值对高龄糖尿病患者造影剂肾病的诊断价值。

方法

回顾性分析875例在济宁医学院附属医院心内科接受PCI患者的临床资料。采用SPSS19.0统计软件进行统计学分析,比较CIN组与非CIN组患者的各项资料,如性别、年龄、吸烟、是否低血压、左室射血分数(LVEF)、血红蛋白值、低密度脂蛋白(LDL-C)、空腹血糖、高血压和2型糖尿病病史;术前血肌酐(Scr)、eGFR;术后48hScr、eGFR。用Logistic回归分析CIN的危险因素。

结果

入组患者CIN患病率4.80%(42例),男性、合并高血压病、2型糖尿病、高脂血症、吸烟、低血压、贫血、发病时心肌梗死合并休克的患病率分别为65.71%、54.86%、37.26%、22.51%、34.17%、16.80%、4.20%、8.91%。CIN与非CIN患者相比,在高龄患者(33.33%,19.33%,χ2=4.902,P<0.05)、患有糖尿病(52.38%,36.49%,χ2=4.317,P<0.05),吸烟(50.00%,33.37%,χ2=4.914,P<0.05),发病时低血压(28.57%,16.21%,χ2=4.374,P<0.05),心肌梗死伴休克(19.05%,8.40%,χ2=5.579,P<0.05),低LVEF[(36.46±9.27)%,(43.62±3.46)%,t=2.398,P<0.05]及造影剂用量大[(154.5±95.3)mL,(115.04±49.63)mL,t=2.069,P<0.05]的患者更容易发生CIN;eGFR在CIN组明显降低[(72.50±15.06)mL/(min·1.73m2),(108.55±21.7)mL/(min·1.73m2),t=7.220,P<0.05]。CMV/eGFR在CIN组与非CIN组间[(2.19±1.30),(1.01±0.40),t= -3.439,P<0.05]差异有统计学意义。多因素回归分析显示高龄(年龄≥70岁,RR=5.27,P<0.05)、糖尿病(RR=9.87,P<0.05)、LVEF(RR=7.35,P<0.05)、术前eGFR(RR=4.12,P<0.05)、心肌梗死合并休克(RR=6.75,P<0.05)、CMV/eGFR(RR=13.45,P<0.05)是CIN的危险因素。ROC工作曲线显示,CMV/eGFR>1.52对于高龄糖尿病患者是否发生CIN的敏感度为72.50%,特异度为84.00%。

结论

PCI前评估患者的危险因素非常重要,高龄糖尿病更容易发生CIN;CMV/eGFR比值是一个独立的能够预测高龄糖尿病患者PCI后能否发生CIN的指标。

Objective

To investigate the incidence of contrast-induced nephropathy(CIN) in patients undergoing percutaneous coronary intervention(PCI) and assess the predictive role of the ratio of contrast medium volume to estimated glomerular filtration rate (CMV/eGFR) in super-elderly diabetic patients undergoing elective PCI who developed CIN.

Methods

Eight hundred and seventy-five PCI patients were retrospectively collected in Affiliated Hospital of Jining Medical University.Patients were divided into CIN group and non-CIN group based on the presence of CIN.Date of the two groups were compared concerning sex, age, smoking, hypotension, LVEF, hemoglobin, LDL-C, glucose, history of hypertension and type 2 diabetes, serum creatinine and eGFR pre-PCI, serum creatinine and eGFR post 48 h-PCI.Risk factors for CIN were analyzed by logistic regression statistical model.

Results

Among eight hundred and seventy-five patients, forty-two patients experienced CIN (4.8%). The disease incidence of male, hypertention, type 2 diabetes, hyperlipidemia, smoking, hypotentino, anemia, myocardial infarction with shock was 65.71%, 54.86%, 37.26%, 22.51%, 34.17%, 16.80%, 4.20%, 8.91%, respectively.In the other two groups, the patients with the super-elderly (age≥70y) (33.33%, 19.33%, χ2=4.902, P<0.05), type 2 diabetes(52.38%, 36.49%, χ2=4.317, P=0.05), smoking(50.00%, 33.37%, χ2=4.914, P<0.05), with hypotention(28.57%, 16.21%, χ2=4.374, P<0.05), myocardial infarction combined with shock(19.05%, 8.40%, χ2=5.579, P<0.05), LVEF[(36.46±9.27)%, (43.62±3.46)%, t=2.398, P<0.05], and larger contrast medium volume[(154.5±95.3)mL, (115.04±49.63)mL, t=2.069, P<0.05] were proned to CIN.eGFR was lower in CIN[(72.50±15.06)ml/(min·1.73m2), (108.55±21.7)ml/(min·1.73m2), t=7.220, P<0.05]. There were significant differences between the two group in CMV/eGFR[(2.19±1.30), (1.01±0.40), t=-3.439, P<0.05]. Logistic regression analysis showed that age ≥70y(RR=5.27, P<0.05), type 2 diabetes(RR=9.87, P<0.05), LVEF(RR=7.35, P<0.05), pre-PCI eGFR(RR=4.12, P<0.05), myocardial infarction with shock(RR=6.75, P<0.05), CMV/eGFR(RR=13.45, P<0.05)were the risk factors for CIN. ROC analysis indicated that a CMV/eGFR of more than 1.5 was a predictor of CIN.The sensitivity and specificity for CIN of CMV/eGFR of more than 1.5 was 72.50% and 84.00%, respectively.

Conclusions

It is very important to estimate risk factors of patients before PCI.The super-elderly diabetic patients are proned to CIN.The CMV/eGFR ratio could be a valuable predictor for CIN in super-elderly diabetic patients after elective PCI.

表1 CIN组与非CIN组患者临床特征比较
表2 发生CIN的多因素Logistic回归分析
图1 造影剂剂量与估计肾小球滤过率比值在高龄糖尿病患者中的预测价值
[1]
Nash K, Hafeez A, Hou S.Hospital-acquired renal insufficiency[J].Am J Kidney Dis,2002,39(5):930-936.
[2]
Parfrey P.The clinical epidemiology of contrast-induced nephropathy[J].Cardiovasc Intervent Radiol,2005,28(Suppl 2):S3-S11.
[3]
Dangas G, Iakovou I, Nikolsky E,et al.Contras-induced nephropaty after percutanetous in relation to chronic kidney disease and hemodynamic variables[J].Am J Cardiol,2005,95(1):13-19.
[4]
Manske CL, Sprafka JM, Strony JT,et al.Contrast nephropathy in azotemic diabetic patients undergoing coronary angiography [J].Am J Med,1990,89(5):615-620.
[5]
De Broe ME, Porter GA, Bennett WM,et al.Clinical nephrotoxins:renal injury from drugs and chemicals[M].Kluwer Academic Publishers,2003.
[6]
Nozue T, Michishita I, Iwaki T,et al.Contrast medium volume to estimated glomerular filtration rate ratio as a predictor of contrast-induced nephropathy developing after elective percutaneous coronary intervention[J].J Cardiol,2009,54(2):214-220.
[7]
Mehran R, Nikolsky E.Contrast-induced nephropathy:definition,epidemiology,and patients at risk[J].Kidney Int Suppl,2006,100:S11-S15.
[8]
Chong E, Poh KK, Liang S,et al.Risk fractors and clinical outcomes for contrast-induced nephropathy after percutaneous coronary intervention in patients with normal serum creatinine[J].Ann Acad Med Singapore,2010,39(5):374-380.
[9]
Wang XC, Fu XH, Wang YB,et al.Prediction of contrast-induced nephropathy in diabetics undergoing elective percutaneous coronary intervention:role of the ratio of contrast medium volume to estimated glomerular filtration rate[J].Chin Med J (Engl),2011,124(6):892-896.
[10]
Ma YC, Zuo L, Chen JH,et al.Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease[J].J Am Soc Nephrol, 2006,17(10):2937-2944.
[11]
Liistro F, Falsini G, Bolognese L.The clinical burden of contrast media-induced nephropathy [J].Ital Heart J,2003,4(10):668-676.
[12]
张洁,赵建华,王志英,等.高龄人造影剂肾病临床相关因素及预防措施[J].中华保健医学杂志,2009,11(4):286-288.
[13]
Mueller C, Buerkle G, Buet tner HJ,et al.Prevention of contrast media-associated nephropathy:randomized comparison of 2 hydration regimens in 1620 patients undergoing coronary angioplasty [J].Arch Intern Med,2002,162(3):329-336.
[14]
Esplugas E, Cequier A, Gomes-Hospital JA,et al.Comparative tolerability of contrast media used for coronary interventions[J].Drug Saf,2002,25(15):1079-1098.
[15]
Nguyen SA, Suranyi P, Ravenel JG,et al.Iso-osmolality versus low-osmolality iodinated contrast medium at intravenous cont rast-enhanced CT:effect on kidney function[J].Radiology,2008,248(1):97-105.
[16]
Toprak O, Cirit M, Yesil M,et al.Metabolic syndrome as a risk factor for contrast-induced nephropathy in non-diabetic elderly patients with renal impairment[J].Kidney Blood Press Res,2006,29(1):2-9.
[17]
Zhang Pian, Ni Zhaohui, Wang Ling,et al.A Multi-center clinical study of contrast-induced nephropathy in inpatients in cardiology department after coronary artery intervention[J].Chinese Journal of Blood Purification,2010,9(7):375-370.
[18]
Bartholomew BA, Harjai KJ, Dukkipati S,et al.Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification[J].Am J Cardiol,2004,93(12):1515-1519.
[19]
Nikolsky E, Mehran R, Turcot D,et al.Impact of chronic kidney disease on prognosis of patients with diabetes mellitus treated with percutaneouscoronary intervention[J].Am J Cardiol, 2004,94(3):300-305.
[20]
Asif A, Preston RA, Roth D.Radiocontrast-induced nephropathy[J].Am J Ther,2003,10(2):137-147.
[21]
Rubenstein MH, Sheynberg BV, Harrell LC,et al.Effectiveness and adverse events after percutaneous coronary intervention in patients with mild versus severe renal failure[J].Am J Cardiol,2001,87(7):856-860.
[22]
郭敏,邹阳春.造影剂肾病研究进展[J].中华高龄多器官疾病杂志,2010,9(3):286-288.
[23]
Abe M, Kimura T, Morimoto T,et al.Incidence of and risk factors for contrast-induced nephropathy after cardiac catheterization in Japanese patients[J].Circ J,2009,73(8):15l8-1522.
[24]
Freeman RV, O’Donnell M, Share D,et al.Nephropathy requiring dialysis after percutaneous coronary intervention and the critical role of an adjusted contrast dose[J].Am J Cardiol,2002,90(10):1068-1073.
[25]
Sherwin PF, Cambron R, Johnson JA,et al.Contrast dose-to-creatinine clearance ratio as a potential indicator of risk for radiocontrast-induced nephropathy:correlation of D/CrCL with area under the contrast concentrationtime curve using iodixanol[J].Invest Radiol,2005,40(9):598-603.
[26]
Worasuwannarak S, Pornratanarangsi S.Prediction of contrast-induced nephropathy in diabetic patients undergoing elective cardiac catheterization or PCI:role of volume-to-creatinine clearance ratio and iodine dose-to-creatinine clearance ratio[J].J Med Assoc Thai,2010,93 (Suppl 1):S29-S34.
[27]
National Kidney Foundation.K/DOQI clinical practice guidelines for chronic kidney disease:evaluation,classification,and stratification[J].Am J Kidney Dis,2002,39 (2 Suppl 1):S1-S266.
[28]
杨志寅.现代医学科学发展中的缺憾与思考[J/CD].中华诊断学电子杂志,2013,1(1):1-7.
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