中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2012年
7期
538-543
,共6页
杨妍姣%唐骁%周莹%郑寅%陈颖颖%郭大乔%丁峰
楊妍姣%唐驍%週瑩%鄭寅%陳穎穎%郭大喬%丁峰
양연교%당효%주형%정인%진영영%곽대교%정봉
造影剂%危险因素%血清胱抑素C%造影剂肾病%血管腔内治疗术
造影劑%危險因素%血清胱抑素C%造影劑腎病%血管腔內治療術
조영제%위험인소%혈청광억소C%조영제신병%혈관강내치료술
Contrast media%Risk factors%Serum cystatin C%Contrast-induced nephropathy%Endovascular therapy
目的 分析腔内治疗周围动脉疾病术后造影剂肾病( CIN)发生的危险因素,以及血清胱蛋白酶抑制剂C(Cys C)与血清肌酐(Scr)在诊断肾损伤时的符合情况.方法 本研究为前瞻性、单中心研究,2010年7月至2011年4月在本院血管外科接受非急诊周围动脉疾病腔内治疗术的住院患者入选.根据造影后Scr升高≥25％标准判断是否发生CIN,分为非CIN组和CIN组,比较两组患者的一般临床资料和血液生化指标；行相关危险因素的Logistic回归分析；分析造影前后Scr和血清Cys C变化分布以及两者诊断CIN的符合情况.结果 367例患者入选.CIN组并发糖尿病比例、造影剂用量、术前利尿剂合并用药比例均显著高于非CIN组,差异有统计学意义(P分别＜0.05、＜0.01、＜0.01).Logistic回归分析结果显示,并发糖尿病、造影剂用量为CIN的危险因素.采用术后24 h血清Cys C任何程度的升高、升高≥5％、≥8％、≥10％、≥15％、≥25％及绝对值升高≥0.2 mg/L标准预测Scr诊断标准诊断的CIN的灵敏度均较低.维恩图显示两指标诊断肾损伤患者的集合重叠区域均较小.结论 造影剂用量、糖尿病为CIN发生的独立危险因素.造影后血清Cys C升高标准与Scr标准在诊断肾损伤上符合情况较差.
目的 分析腔內治療週圍動脈疾病術後造影劑腎病( CIN)髮生的危險因素,以及血清胱蛋白酶抑製劑C(Cys C)與血清肌酐(Scr)在診斷腎損傷時的符閤情況.方法 本研究為前瞻性、單中心研究,2010年7月至2011年4月在本院血管外科接受非急診週圍動脈疾病腔內治療術的住院患者入選.根據造影後Scr升高≥25％標準判斷是否髮生CIN,分為非CIN組和CIN組,比較兩組患者的一般臨床資料和血液生化指標；行相關危險因素的Logistic迴歸分析；分析造影前後Scr和血清Cys C變化分佈以及兩者診斷CIN的符閤情況.結果 367例患者入選.CIN組併髮糖尿病比例、造影劑用量、術前利尿劑閤併用藥比例均顯著高于非CIN組,差異有統計學意義(P分彆＜0.05、＜0.01、＜0.01).Logistic迴歸分析結果顯示,併髮糖尿病、造影劑用量為CIN的危險因素.採用術後24 h血清Cys C任何程度的升高、升高≥5％、≥8％、≥10％、≥15％、≥25％及絕對值升高≥0.2 mg/L標準預測Scr診斷標準診斷的CIN的靈敏度均較低.維恩圖顯示兩指標診斷腎損傷患者的集閤重疊區域均較小.結論 造影劑用量、糖尿病為CIN髮生的獨立危險因素.造影後血清Cys C升高標準與Scr標準在診斷腎損傷上符閤情況較差.
목적 분석강내치료주위동맥질병술후조영제신병( CIN)발생적위험인소,이급혈청광단백매억제제C(Cys C)여혈청기항(Scr)재진단신손상시적부합정황.방법 본연구위전첨성、단중심연구,2010년7월지2011년4월재본원혈관외과접수비급진주위동맥질병강내치료술적주원환자입선.근거조영후Scr승고≥25％표준판단시부발생CIN,분위비CIN조화CIN조,비교량조환자적일반림상자료화혈액생화지표；행상관위험인소적Logistic회귀분석；분석조영전후Scr화혈청Cys C변화분포이급량자진단CIN적부합정황.결과 367례환자입선.CIN조병발당뇨병비례、조영제용량、술전이뇨제합병용약비례균현저고우비CIN조,차이유통계학의의(P분별＜0.05、＜0.01、＜0.01).Logistic회귀분석결과현시,병발당뇨병、조영제용량위CIN적위험인소.채용술후24 h혈청Cys C임하정도적승고、승고≥5％、≥8％、≥10％、≥15％、≥25％급절대치승고≥0.2 mg/L표준예측Scr진단표준진단적CIN적령민도균교저.유은도현시량지표진단신손상환자적집합중첩구역균교소.결론 조영제용량、당뇨병위CIN발생적독립위험인소.조영후혈청Cys C승고표준여Scr표준재진단신손상상부합정황교차.
Objective To investigate the risk factors for contrast-induced nephropathy (CIN) after endovascular therapy in patients with peripheral arterial diseases and to evaluate the conformance of serum cystatin C (Cys C) and serum creatinine in diagnosis of CIN. Methods In this prospective,single center study,in-hospital patients with peripheral arterial diseases undergoing non-emergency endovascular therapy from July 2010 to April 2011 in our hospital were enrolled.CIN was defined as Scr increase ≥25％ after angiography.General clinical characteristics and blood biochemical parameters were compared between the non-CIN and CIN groups.Logistic regression analysis was performed to determine risk factors.Changes compared to baseline level in serum creatinine and Cys C at predefined time-points were evaluated. Results A total of 367 patients were enrolled in the study.The proportions of patients with diabetes mellims and treatment with diuretics before angiography,contrast-media dosage were significantly higher in the CIN group than those in non-CIN group (P＜0.05,＜0.01,＜0.01).Logistic regression analysis indicated that diabetes mellitus,contrast-media dosage were risk factors for CIN.Several serum Cys C increase criteria at 24 hours after contrast media exposure all had low sensitivity for predicting a Scr increase ≥25％.Only small overlapped regions were found in Venn diagram between several increasing criteria according to serum Cys C and serum creatinine criterion. Conclusions Diabetes mellitus,contrast-media dosage are independent risk factors for CIN.The results of several increasing criteria according to serum Cys C in evaluating contrast-induced AKI are not coincident well with that of serum creatinine criterion.
