摘要
目的探讨接受经皮冠状动脉造影(CAG)检查的急性冠脉综合征(ACS)患者,H型高血压与对比剂肾病(CIN)是否具有某种联系。方法选取接受CAG检查的ACS患者275例,其中H型高血压189例,非H型高血压86例,分析患者临床基线资料、血肌酐(Cr)、估算肾小球滤过率(eGFR)和CIN危险因素。结果 CIN发病率H型高血压(n=31,16.4%)高于非H型高血压(n=7,8.1%),差异有统计学意义(P <0.05);术后72 h内H型高血压血Cr水平[(83.79±29.62)vs.(66.82±26.31)μmol/L]高于非H型高血压,H型高血压eGFR水平[(66.81±20.92)vs.(75.29±18.28) mL/min]低于非H型高血压,差异均有统计学意义(P <0.05);Logistic回归分析显示,高龄、贫血、糖尿病、慢性肾病、H型高血压、对比剂用量和左心室射血分数降低是CIN的主要危险因素(P <0.05)。结论 H型高血压可能是CIN的危险因素之一。
Objective To explore the relationship between H-type hypertension and contrast induced nephropathy(CIN) after percutaneous coronary angiography(CAG) in patients with acute coronary syndrome(ACS). Methods 275 ACS patients who underwent CAG examination were selected,including 189 patients with H-type hypertension and 86 patients with non-H-typy hypertension. The baseline clinical data,serum creatinine,glomerular filtration rate and CIN risk factors were analyzed. Results The incidence of CIN in H-type hypertension group(31 cases,16.4%)was higher than that in non-H-type hypertension group(7 cases,8.1%)(P < 0.05).The Cr in H-type hypertension group was higher than that of non-H-type hypertension group within 72 hours after operation[(83.79 ± 29.62)vs.(66.82 ± 26.31)μmol/L],and the eGFR in H-type hypertension group was lower than that of non-H-type hypertension group[(66.81 ± 20.92)vs.(75.29 ± 18.28)mL/min],the difference was statistically significant(P < 0.05). Logistic regression analysis showed that age,anemia,diabetes,chronic kidney disease,H-type hypertension,dosage of contrast agent,and left ventricular ejection fraction were the main risk factors for CIN after CAG(P < 0.05). Conclusion The H-type hypertension maybe one of the risk factors for CIN after CAG.
引文
[1] LLOYD-JONES D,ADAMS R J,BROWN T M,et al. Heart disease and strokestatisticsd2010 update[J]. Circulation,2010,121(7):948-954.
[2] NASH K,HAFEEZ A,HOU S. Hospital-acquired renal insufficiency[J]. Am J Kidney Dis,2002,39(5):930-936.
[3]胡大一,徐希平.有效控制“H型”高血压-预防脑卒中的新思路[J].中华内科杂志,2008,47(12):976-977.
[4]梁君铭,骆雪梅.探索H型高血压对肾功能不全患者的影响[J].白求恩医学杂志,2015,13(2):199-200.
[5]郑卫峰,王晓阳,张守彦. H型高血压与冠心病合并慢性心力衰竭患者肾功能不全的关系[J].中国动脉硬化杂志,2014,22(5):505-508.
[6] GIBBONS R J,ABRALMS J,CHATTERJEE K,et al. ACC/AHA 2002 guidelines update for the management of patients with chronic stable angina-summary article:a report of the American college of Cardiology/Aineriea Heart Association Task Force on practice guideline(Committee on the Management of Patients With Chronic Stable Angina)[J]. Circulation,2003,107(l):149-158.
[7]中国高血压防治指南修订委员会.中国高血压防治指南2010年修订版[J].中国医学前沿杂志电子版,2011,3(5):42-91.
[8] 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.
[9] SHACHAM Y,GAL-OZ A,LESHEM-RUBINOW E,et al. Association of admission hemoglobin levels and acute kidney injury among myocardialinfarction patients treated with primary percutaneous intervention[J]. Can J Cardiol 2015,31(1):50-55.
[10] MCCULLOUGH P A,SOMAN S S. Contrast-induced nephropathy[J]. Crit Care Clin,2005,21(2):261-280.
[11] KEANEY J J,HANNON C M,MURRAY P T. Contrast-induced acute kidneyinjury:how much contrast is safe?[J]. Nephrol Dial Transplant,2013,28(6):1376-1383.
[12] KURTUL A,DURAN M,YARLIOGLUES M,et al. Association between N-terminal pro-brain natriuretic peptide levels and contrast-induced nephropathy in patients undergoing percutaneous coronary intervention for acute coronary syndrome[J]. Clin Cardiol,2014,37(8):485-492.
[13] SEELIGER E,SENDESKI M,RIHAL C S,et al. Contrast-induced kidneyinjury:Mechanisms,risk factors,and prevention[J]. Eur Heart J,2012,33(16):2007-2015.
[14] FOX C S,MUNTNER P,CHEN A Y,et al. Short-term outcomes of acute myocardial infarction in patients with acute kidney injury:A report from the national cardiovascular data registry[J]. Circulation,2012,125(3):497-504.
[15] OWEN R J,HIREMATH S,MYERS A,et al. Canadian Association of Radiologists consensus guidelines for the prevention of contrast induced nephropathy:Update 2012[J]. Can Assoc Radiol J,2014,65(2):96-105.
[16]陈思,陈韵岱,钱赓,等.急性冠状动脉综合征患者冠脉造影术后对比剂肾病危险因素分[J].中国循证心血管医学杂志,2016,8(6):742-745.
[17] CYBULSKA B,KLOSIEWICZ-LATOSZEK L. Homocysteine is it still an important risk factor for cardiovascular disease?[J].Kardiol Pol,2015,73(11):1092-1096.
[18] DE S A FERREIRA A. Plasma homocysteine and arterial stiffness:Risk Factors or risk markers for cardiovascular diseases?[J]. J Clin Hypertens,2015,17(8):601-602.
[19] FISCHER P A,DOMINGUEZ G N,CUNIBERTI L A,et al. Hyperhomocysteinemia induces renal hemodynamic dys-function:Is nitric oxide involved[J]. Am Soc Nephrol,2003,14(3):653-660.
