经皮冠状动脉介入术后造影剂诱发肾病的风险因素:观察性研究

Ahmad Ali Abdo, Hani Abdelshafook Khalaf
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摘要

背景:造影剂诱发肾病(CIN)是指使用碘造影剂后肾功能暂时性下降。识别高危患者并采取适当的预防措施对降低 CIN 发病率至关重要。研究目的本研究旨在调查经皮冠状动脉介入治疗(PCI)后与 CIN 相关的风险。患者和方法:这项前瞻性观察研究纳入了 500 名年龄在 18 岁或以上、肾小球滤过率 (GFR) 在 60 ml/min/1.73 m² 或以上、于 2022 年 1 月至 2023 年 8 月期间在 Al-Husain 大学医院接受 PCI 治疗的患者。结果高血压会明显增加PCI术后发生AKI的风险[调整后OR = 15.34 (4.77-60.36, p<0.001)]。调整血红蛋白水平可明显降低发生 AKI 的风险[调整 OR = 0.26 (0.12-0.53, p<0.001)],但低密度脂蛋白水平升高会增加 PCI 后发生 AKI 的风险[调整 OR = 1.05 (1.02-1.08, p=0.002)],而高密度脂蛋白水平降至正常以下会明显增加发生 AKI 的风险[调整 OR = 1.21 (1.03-1.46, p=0.030)]。结论高血压、血脂异常、造影剂量和心脏参数受损会明显增加PCI术后发生AKI的风险,而较高的血红蛋白水平则具有保护作用。
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Risk Factors of Contrast-Induced Nephropathy after Percutaneous Coronary Interventions: An Observational Study
Background: Contrast-induced nephropathy (CIN) refers to a temporary decline in kidney function after using iodinated contrast agents. Identifying high-risk patients and implementing suitable preventive measures are crucial for reducing CIN incidence. Objective: This study aimed to investigate risks associated with CIN after percutaneous coronary interventions (PCI). Patients and methods: This prospective observational study included 500 patients aged 18 years or older with a glomerular filtration rate (GFR) of 60 ml/min/1.73 m² or higher who underwent PCI at Al-Husain University Hospital between January 2022 and August 2023. Results: Hypertension significantly increased the risk of AKI after PCI [adjusted OR = 15.34 (4.77-60.36, p<0.001)]. Adjustment of hemoglobin level significantly decreased the risk of AKI [adjusted OR = 0.26 (0.12-0.53, p<0.001)] but an increased level of LDL increased the risk of AKI after PCI [adjusted OR = 1.05 (1.02-1.08, p=0.002)] and decrease of HDL level below normal significantly increased the level of AKI [adjusted OR = 1.21 (1.03-1.46, p=0.030)]. Conclusion: Hypertension, dyslipidemia, contrast volume, and impaired cardiac parameters significantly increased the risk of AKI following PCI, while higher hemoglobin levels were protective.
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