术前尿微量白蛋白/尿肌酐比值与造影剂肾病的相关性研究
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摘要
目的:探讨术前尿微量白蛋白/尿肌酐比值水平(UACR)对早期发现冠状动脉造影/介入治疗术后造影剂肾病(CIN)的预测价值。方法:收集2016年11月至2017年9月期间于东南大学附属中大医院心血管内科住院择期行冠状动脉造影/介入治疗的180名患者的基线资料,根据术前UACR水平将患者分为高UACR组(UACR≥30,n=35例)和对照组(UACR<30,n=145例)。根据是否发生CIN分为CIN组(n=32例)和非CIN组(n=148例)。采用多因素Logistic回归分析术后发生造影剂肾病的危险因素。结果:180例患者中有32例发生造影剂肾病,发生率为17.78%。高UACR组发生CIN的比例显著高于对照组(P<0.001)。CIN组患者中高UACR的比例显著高于非CIN组(P<0.001)。多因素Logistic回归分析显示,术前UACR水平(P<0.001,95%CI:3.819～29.223,OR:10.564)是发生CIN的独立危险因素。结论:术前UACR水平可成为早期诊断造影剂肾病的独立预测因子。
Objective: To investigate the predictive value of preoperative urinary microalbumin to creatinine ratio(UACR)level for early diagnosis of contrast-induced nephropathy(CIN). Methods: A total of 180 patients scheduled to undergo elective coronary angiography(CAG)/percutaneous coronary intervention(PCI)in our department from November 2016 to September 2017 were selected into this prospective study.Patients were allocated to high UACR group(UACR≥30,n=35)and control group(UACR<30,n=145)according to the UACR level. According to the occurrence of CIN, the patients were slao divided into CIN group(n=32) and non CIN group(n=148). Multivariable logistic regression model was used to investigate the risk factors of CIN. Results: Thirty-two patients developed CIN(17.78%).The incidence of CIN was significantly higher in high UACR group than that in the control group(P<0.001).The ratio of high UACR in CIN group was significantly higher than that in non CIN group(P<0.001).Multivariable logistic regression analysis indicated that the level of preoperative UACR(OR:10.564,95%CI:3.819～29.223,P<0.001)was an independent risk factor of CIN. Conclusion: The level of preoperative UACR appears to be an independent predictive factor for early diagnosis of CIN.
Objective: To investigate the predictive value of preoperative urinary microalbumin to creatinine ratio(UACR)level for early diagnosis of contrast-induced nephropathy(CIN). Methods: A total of 180 patients scheduled to undergo elective coronary angiography(CAG)/percutaneous coronary intervention(PCI)in our department from November 2016 to September 2017 were selected into this prospective study.Patients were allocated to high UACR group(UACR≥30,n=35)and control group(UACR<30,n=145)according to the UACR level. According to the occurrence of CIN, the patients were slao divided into CIN group(n=32) and non CIN group(n=148). Multivariable logistic regression model was used to investigate the risk factors of CIN. Results: Thirty-two patients developed CIN(17.78%).The incidence of CIN was significantly higher in high UACR group than that in the control group(P<0.001).The ratio of high UACR in CIN group was significantly higher than that in non CIN group(P<0.001).Multivariable logistic regression analysis indicated that the level of preoperative UACR(OR:10.564,95%CI:3.819～29.223,P<0.001)was an independent risk factor of CIN. Conclusion: The level of preoperative UACR appears to be an independent predictive factor for early diagnosis of CIN.
引文
[1] CHALIKIAS G,DROSOS I,TZIAKAS D N.Prevention of contrast- induced acute kidney injury:an update.cardiovasc drugs[J].Ther,2016,30(5):515- 524.
[2] HU X,ZHUANG X D,LI Y,et al.A nomogram to predict contrast induced nephropathy in patients undergoing percutaneous coronary intervention[J].Int Heart J,2017,58(2):191- 196.
[3] WYBRANIEC M T,MIZIA- STEC K,WIECEK A.Contrast- induced acute kidney injury:the dark side of cardiac catheterization[J].Pol Arch Med Wewn,2015,125(12):938- 949.
[4] AZZALINI L,SPAGNOLI V,LY H Q.Contrast- induced nephropathy:from pathophysiology to preventive strategies[J].Can J Cardiol,2016,32(2):247- 255.
[5] JORGRNSEN A L.Contrast- induced nephropathy:pathophysiology and preventive strategies[J].Crit Care Nurse,2013,33(1):37- 46.
[6] HOMMA K.Contrast- induced acute kidney injury[J].Keio J Med,2016,65(4):67- 73.
[7] CRUZ D N,RICCI Z,RONCO C.Clinical review:RIFLE and AKIN- time for reappraisal[J].Crit Care,2009,13(3):211.
[8] WYBRANIEC M T,MIZIA- STEC K.Renalase and biomarkers of contrast- induced acute kidney injury[J].Cardiorenal Med,2015,6(1):25- 36.
[9] ANDREUCCI M,FAGA T,RICCIO E,et al.The potential use of biomarkers in predicting contrast- induced acute kidney injury[J].Int J Nephrol Renovasc Dis,2016,9:205- 221.
[10] STACUL F,V A N DER MOLEN A J,REIMER P,et al.Contrast induced nephropathy:updated ESUR contrast media safety committee guidelines[J].Eur Radiol,2011,21(12):2527- 2541.
[11] MORCOS S K,THOMSEN H S,WEBB J A.Contrast- media- induced nephrotoxicity:a consensus report.contrast media safety committee,European Society of Urogenital Radiology(ESUR)[J].Eur Radiol,1999,9(8):1602- 1613.
[12] LEVEY A S,ECKARDT K U,TSUKAMOTO Y,et al.Definition and classification of chronic kidney disease:a position statement from Kidney Disease:Improving Global Outcomes(KDIGO)[J].Kidney Int,2005,67(6):2089- 2100.
[13] OZKOK S,OZKOK A.Contrast- induced acute kidney injury:a review of practical points[J].World J Nephrol,2017,6(3):86- 99.
[14] GALLEGOS Y,TAHA A A,RUTLEDGE D N.Ce:preventing contrast- induced acute kidney injury[J].Am J Nurs,2016,116(12):38- 45.
[15] KOBALAVA Z D,VILLEVALDE S V,GASKINA A A,et al.Contrast- induced acute kidney injury after primary percutaneous coronary interventions:prevalence,predictive factors,and outcomes[J].Ter Arkh,2015,87(6):50- 55.
[16] TAKAYAMA T,YODA S,YAJIMA Y,et al.Improvements in augmentation index and urinary albumin excretion with benidipine in hypertensive patients with chronic kidney disease[J].Int Heart J,2016,57(1):53- 60.
[17] K/DOQI clinical practice guidelines for chronic kidney disease:evaluation,classification,and stratification[J].Am J Kidney Dis,2002,39(2 Suppl 1):S1- 266.
[18] ZHAO H,JIANG Y F,ZHOU X C,et al.An effective indicator in predicting cardiovascular events:urine albumin to creatinine ratio[J].Eur Rev Med Pharmacol Sci,2017,21(14):3290- 3295.
[19] MANN J F,GERSTEIN H C,POGUE J,et al.Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril:the HOPE randomized trial[J].Ann Intern Med,2001,134(8):629- 636.
[20] 郭琴,罗薇,银代淑,等.体检人群尿微量白蛋白肌酐比的临床意义[J].四川大学学报:医学版,2016,47(1):122- 127.
[21] WICHMANN J L,KATZBERG R W,LITWIN S E,et al.Contrast- induced nephropathy[J].Circulation,2015,132(20):1931- 1936.
[2] HU X,ZHUANG X D,LI Y,et al.A nomogram to predict contrast induced nephropathy in patients undergoing percutaneous coronary intervention[J].Int Heart J,2017,58(2):191- 196.
[3] WYBRANIEC M T,MIZIA- STEC K,WIECEK A.Contrast- induced acute kidney injury:the dark side of cardiac catheterization[J].Pol Arch Med Wewn,2015,125(12):938- 949.
[4] AZZALINI L,SPAGNOLI V,LY H Q.Contrast- induced nephropathy:from pathophysiology to preventive strategies[J].Can J Cardiol,2016,32(2):247- 255.
[5] JORGRNSEN A L.Contrast- induced nephropathy:pathophysiology and preventive strategies[J].Crit Care Nurse,2013,33(1):37- 46.
[6] HOMMA K.Contrast- induced acute kidney injury[J].Keio J Med,2016,65(4):67- 73.
[7] CRUZ D N,RICCI Z,RONCO C.Clinical review:RIFLE and AKIN- time for reappraisal[J].Crit Care,2009,13(3):211.
[8] WYBRANIEC M T,MIZIA- STEC K.Renalase and biomarkers of contrast- induced acute kidney injury[J].Cardiorenal Med,2015,6(1):25- 36.
[9] ANDREUCCI M,FAGA T,RICCIO E,et al.The potential use of biomarkers in predicting contrast- induced acute kidney injury[J].Int J Nephrol Renovasc Dis,2016,9:205- 221.
[10] STACUL F,V A N DER MOLEN A J,REIMER P,et al.Contrast induced nephropathy:updated ESUR contrast media safety committee guidelines[J].Eur Radiol,2011,21(12):2527- 2541.
[11] MORCOS S K,THOMSEN H S,WEBB J A.Contrast- media- induced nephrotoxicity:a consensus report.contrast media safety committee,European Society of Urogenital Radiology(ESUR)[J].Eur Radiol,1999,9(8):1602- 1613.
[12] LEVEY A S,ECKARDT K U,TSUKAMOTO Y,et al.Definition and classification of chronic kidney disease:a position statement from Kidney Disease:Improving Global Outcomes(KDIGO)[J].Kidney Int,2005,67(6):2089- 2100.
[13] OZKOK S,OZKOK A.Contrast- induced acute kidney injury:a review of practical points[J].World J Nephrol,2017,6(3):86- 99.
[14] GALLEGOS Y,TAHA A A,RUTLEDGE D N.Ce:preventing contrast- induced acute kidney injury[J].Am J Nurs,2016,116(12):38- 45.
[15] KOBALAVA Z D,VILLEVALDE S V,GASKINA A A,et al.Contrast- induced acute kidney injury after primary percutaneous coronary interventions:prevalence,predictive factors,and outcomes[J].Ter Arkh,2015,87(6):50- 55.
[16] TAKAYAMA T,YODA S,YAJIMA Y,et al.Improvements in augmentation index and urinary albumin excretion with benidipine in hypertensive patients with chronic kidney disease[J].Int Heart J,2016,57(1):53- 60.
[17] K/DOQI clinical practice guidelines for chronic kidney disease:evaluation,classification,and stratification[J].Am J Kidney Dis,2002,39(2 Suppl 1):S1- 266.
[18] ZHAO H,JIANG Y F,ZHOU X C,et al.An effective indicator in predicting cardiovascular events:urine albumin to creatinine ratio[J].Eur Rev Med Pharmacol Sci,2017,21(14):3290- 3295.
[19] MANN J F,GERSTEIN H C,POGUE J,et al.Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril:the HOPE randomized trial[J].Ann Intern Med,2001,134(8):629- 636.
[20] 郭琴,罗薇,银代淑,等.体检人群尿微量白蛋白肌酐比的临床意义[J].四川大学学报:医学版,2016,47(1):122- 127.
[21] WICHMANN J L,KATZBERG R W,LITWIN S E,et al.Contrast- induced nephropathy[J].Circulation,2015,132(20):1931- 1936.