CAJ | 학술논문

目的：探讨贫血与经皮冠状动脉介入术（ PCI）后对比剂诱导的急性肾损伤（ CI-AKI）的关系。方法选取天津市胸科医院心内科2008年1月-2010年5月行PCI的冠心病患者1500例，于PCI前及PCI后72 h内检测血肌酐水平。CI-AKI定义为PCI后72 h内测定血肌酐较术前水平增加44.2μmol/L或升高25%以上。贫血定义为血红蛋白（ Hb）<110 g/L（女性）或<120 g/L（男性）。以各项临床及实验室检查指标为自变量，分别以CI-AKI及贫血为因变量，应用多元 Logistic 回归分析CI-AKI及贫血的危险因素。结果1500例行 PCI 患者中共有295例（19.7%）发生贫血，246例（16.4%）发生CI-AKI。贫血组与非贫血组CI-AKI发病率分别为29.2%（86/295）和13.3%（160/1205）（P<0.05）；伴有肾功能不全者中，贫血组和非贫血组 CI-AKI发病率分别为39.4%（26/66）和24.6%（46/187）（P<0.05）；在肾功能正常者中，贫血组和非贫血组CI-AKI发病率分别为26.2%（60/229）和11.2%（114/1018）（P<0.05）。多元Logistic回归分析显示，贫血是PCI后发生CI-AKI的危险因素〔OR（95%CI）=1.85（1.31，2.61）〕，而高龄、肾功能不全及左心室射血分数（ LVEF）≤50%是冠心病患者发生贫血的危险因素〔OR（95%CI）=1.47（1.37，1.70）；1.93（1.41，2.65）；1.62（1.20，2.17）〕。结论无论患者是否伴有肾功能不全，贫血均是冠心病患者PCI后发生CI-AKI的危险因素。
목적：탐토빈혈여경피관상동맥개입술（ PCI）후대비제유도적급성신손상（ CI-AKI）적관계。방법선취천진시흉과의원심내과2008년1월-2010년5월행PCI적관심병환자1500례，우PCI전급PCI후72 h내검측혈기항수평。CI-AKI정의위PCI후72 h내측정혈기항교술전수평증가44.2μmol/L혹승고25%이상。빈혈정의위혈홍단백（ Hb）<110 g/L（녀성）혹<120 g/L（남성）。이각항림상급실험실검사지표위자변량，분별이CI-AKI급빈혈위인변량，응용다원 Logistic 회귀분석CI-AKI급빈혈적위험인소。결과1500례행 PCI 환자중공유295례（19.7%）발생빈혈，246례（16.4%）발생CI-AKI。빈혈조여비빈혈조CI-AKI발병솔분별위29.2%（86/295）화13.3%（160/1205）（P<0.05）；반유신공능불전자중，빈혈조화비빈혈조 CI-AKI발병솔분별위39.4%（26/66）화24.6%（46/187）（P<0.05）；재신공능정상자중，빈혈조화비빈혈조CI-AKI발병솔분별위26.2%（60/229）화11.2%（114/1018）（P<0.05）。다원Logistic회귀분석현시，빈혈시PCI후발생CI-AKI적위험인소〔OR（95%CI）=1.85（1.31，2.61）〕，이고령、신공능불전급좌심실사혈분수（ LVEF）≤50%시관심병환자발생빈혈적위험인소〔OR（95%CI）=1.47（1.37，1.70）；1.93（1.41，2.65）；1.62（1.20，2.17）〕。결론무론환자시부반유신공능불전，빈혈균시관심병환자PCI후발생CI-AKI적위험인소。
Objective To investigate the relationship of anemia to contrast induced-acute kidney injury( CI-AKI) after percutaneous coronary intervention( PCI). Methods A total of 1 500 patients from Department of Cardiology,Tianjin Chest Hospital were selected,which with coronary heart disease(CHD)underwent PCI from January 2008 to May 2010. Serum creatinine(Scr)level was determined before PCI and 72 h after. CI-AKI was defined as an absolute increase by≥44. 2μmol/L or a relative increase by≥25% in Scr within 72 hours after PCI. Anemia was defined as a level of hemoglobin( Hb)<120 g/L in man or <110 g/L in woman. Taking clinical and laboratory indicators as independent variables,CI-AKI and anemia as dependent variables,multivariate Logistic regression analysis was performed to identify risk factors of CI-AKI and anemia. Re-sUlts Among the 1 500 patients,295(19. 7%)had anemia,246(16. 4%)had CI -AKI. The CI -AKI incidences of groups anemia,non-anemia were 29. 2%(86/295),13. 3%(160/1 205),respectively(P<0. 05). CI-AKI incidences of groups anemia,non-anemia were 39. 4%(26/66),24. 6%(46/187),respectively,in the patients combined with renal dysfunction(P<0. 05),and 26. 2%(60/229),11. 2%(114/1 018),respectively,in those with normal renal function (P<0. 05). By multivariate Logistic regression analysis,anemia was a risk factor of CI-AKI after PCI〔OR(95%CI) =1. 85(1. 31,2. 61)〕,and advanced age,renal dysfunction,LVEF≤50% were risk factors of anemia in CHD patients〔OR (95%CI) = 1. 47(1. 37,1. 70);1. 93(1. 41,2. 65);1. 62(1. 20,2. 17)〕. ConclUsion Anemia is a risk factor of CI-AKI in CHD patients after PCI regardless of whether the patients have renal dysfunction or not.