高敏C反应蛋白与经皮冠状动脉介入治疗患者对比剂肾病的相关性

被引：17

作者：

何谊婷

谭宁

刘远辉

陈世群

刘勇

黄水金

杨大浩

叶飘

冉鹏

机构：

[1] 广东省心血管病研究所

[2] 广东省人民医院心内科

[3] 广东省科学院

[4] 四川省宜宾学院数学学院

来源：

中华心血管病杂志 | 2013年 / 05期

关键词：

C反应蛋白; 造影剂; 肾病; 血管成形术; 经腔; 经皮冠状动脉;

D O I：

暂无

中图分类号：

R692 [肾疾病]; R542 [];

学科分类号：

1002 ; 100201 ; 100210 ;

摘要：

目的探讨高敏C反应蛋白(hs-CRP)与急性ST段抬高型心肌梗死患者行急诊经皮冠状动脉介入治疗后对比剂肾病(CIN)的相关性。方法入选220例行急诊经皮冠状动脉介入治疗的ST段抬高型心肌梗死患者。按hs-CRP水平的四分位数间距,将患者分为4组:Q1组(hs-CRP<6.26mg/L),Q2组(hs-CRP 6.26～14.44 mg/L),Q3组(hs-CRP 14.45～33.08 mg/L),Q4组(hs-CRP>33.08 mg/L)。比较4组之间的基线资料、CIN发生率及院内临床事件。对比剂肾病定义为使用对比剂后48～72 h血肌酐值比基线值升高超过5 mg/L。采用受试者工作特征(ROC)曲线及logistics回归分析评估hs-CRP与CIN风险的相关性。结果 220例患者中,21(9.8%)例患者发生CIN。Q1、Q2、Q3和Q4组的CIN发生率分别为1.8%(1/55)、1.8%(1/55)、14.5%(8/55)和20.0%(11/55)(趋势检验,P<0.01);院内病死率、需肾脏替代治疗的比例差异均无统计学意义(趋势检验,P均>0.05)。ROC曲线显示:hs-CRP界值为16.85 mg/L时,其预测CIN的敏感度为81.0%,特异度为61.8%,曲线下面积0.748。单因素logistics回归分析显示,hs-CRP水平与CIN发病率显著相关(OR=6.88,95%CI:2.23～21.21,P<0.01)。多因素logistics回归分析显示,校正性别、贫血、使用血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂、应用主动脉内球囊反搏、左心室射血分数<40%、年龄>75岁、基线估算肾小球滤过率、糖尿病史后,hs-CRP>16.85 mg/L是CIN的独立危险因子(OR=15.91,95%CI:3.43～73.85,P<0.01);年龄>75岁(OR=7.27,95%CI:1.85～28.63,P<0.01)及基线估算肾小球滤过率(OR=6.38,95%CI:1.48～27.41,P<0.05)与CIN发生率显著相关。结论行急诊经皮冠状动脉介入治疗的急性ST段抬高型心肌梗死患者的hs-CRP水平与CIN相关,hs-CRP升高的患者发生CIN的风险增高。

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