论文部分内容阅读
目的:探讨糖尿病患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后对比剂肾病(contrast-induced nephropathy,CIN)的危险因素和预后。方法:回顾性分析2009年1月至2013年5月于我院行PCI的1 481例冠心病患者的临床资料,分为糖尿病组(n=375)和非糖尿病组(n=1 106)。观察2组患者PCI术后肾功能变化及CIN发生率,分析糖尿病患者PCI术后CIN发生的危险因素及预后。结果:PCI术后非糖尿病组胱抑素C(cystatin C,CysC)和血清肌酐(serum creatinine,Scr)水平显著低于糖尿病组(P<0.05);肾小球滤过率估计值(estimated glomerular filtration rate,e GFR)水平明显高于糖尿病组(P<0.05)。糖尿病组和非糖尿病组CIN发生率分别为36.8%和16.0%(P<0.001)。多因素Cox回归分析显示,高血压、心衰、贫血、袢利尿剂、肾功能不全、术前GFR、对比剂用量和术前口服二甲双胍是糖尿病患者PCI术后CIN发生的独立危险因素(P<0.05)。Kaplan-Meier生存分析显示CIN组两年生存率明显低于非CIN组(P<0.001)。结论:糖尿病患者PCI术后CIN发生率高且生存率明显下降,其危险因素包括高血压、心衰、贫血、袢利尿剂、肾功能不全、术前GFR、对比剂用量和术前口服二甲双胍。
Objective: To investigate the risk factors and prognosis of diabetic nephropathy after percutaneous coronary intervention (PCI). Methods: The clinical data of 1 481 CHD patients who underwent PCI in our hospital from January 2009 to May 2013 were retrospectively analyzed. They were divided into diabetic group (n = 375) and non-diabetic group (n = 1,106). The changes of renal function and the incidence of CIN after PCI in both groups were observed, and the risk factors and prognosis of CIN after PCI were analyzed. Results: The levels of cystatin C (CysC) and serum creatinine (Scr) in non-diabetic patients after PCI were significantly lower than those in diabetic patients (P <0.05). The estimated glomerular filtration rate filtration rate, e GFR) were significantly higher than those in the diabetic group (P <0.05). The incidence of CIN in diabetic and non-diabetic patients was 36.8% and 16.0%, respectively (P <0.001). Multivariate Cox regression analysis showed that hypertension, heart failure, anemia, carbuncle diuretic, renal insufficiency, preoperative GFR, contrast medium and preoperative oral metformin were independent risk factors for CIN after PCI in diabetic patients (P < 0.05). Kaplan-Meier survival analysis showed that the two-year survival rate in CIN group was significantly lower than that in non-CIN group (P <0.001). Conclusion: The incidence of CIN and the survival rate of patients with diabetes mellitus after PCI are high. The risk factors include hypertension, heart failure, anemia, loop diuretic, renal insufficiency, preoperative GFR, contrast medium and preoperative oral metformin.