左心室舒张期末压对冠状动脉介入术后患者造影剂肾病的预测价值
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(1.遵化市第二医院,河北省遵化市 064200;2.唐山市工人医院心内三科,河北省唐山市 063000)

作者简介:

吴广志,副主任医师,主要从事冠心病及心衰治疗,E-mail为wuguangzhi919@sohu.com。通信作者刘长青,博士,主任医师,硕士研究生导师,主要从事心导管介入诊疗,E-mail为lcq1974@sohu.com。

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河北省优秀专家出国培训项目


Left ventricular end diastolic pressure predicts contrast-induced nephropathy in patients undergoing percutaneous coronary intervention
Author:
Affiliation:

1.Zunhua Second People's Hospital, Zunhua, Hebei 064200, China;2.Department of Cardiolgoy, Tangshan Gongren Hospital, Tangshan, Hebei 063000, China)

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    摘要:

    目的 探讨经皮冠状动脉介入治疗(PCI)患者左心室舒张期末压(LVEDP)与造影剂肾病(CIN)的关系。方法 回顾性分析单中心PCI的患者临床资料,探讨LVEDP对CIN发生的预测价值。结果 1 301例患者中有125例(9.61%)发生CIN。确定CIN的危险因素有高龄、女性、慢性肾病、糖尿病史、贫血、心力衰竭、急诊程序等。与非CIN组[(14.4±6.6) mmHg]相比,术后发生CIN的患者平均LVEDP[(18.4±8.7) mmHg]升高(P<0.001);多元回归分析发现,LVEDP≥20 mmHg可独立预测CIN的发生(OR 1.26,95%CI 1.08~1.47),低射血分数患者LVEDP对CIN的预测价值增强。由LVEDP升高所确定的高危患者的造影剂用量与那些未发现的患者相当。结论 LVEDP是CIN的独立预测指标。LVEDP(≥20 mmHg)升高的患者行PCI术后发生CIN的风险较高。在CIN预防中,LVEDP升高所定义的高危患者需要引起临床医生的关注。

    Abstract:

    Aim To evaluate the association between left ventricular end-diastolic pressure (LVEDP) and contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary intervention (PCI). Methods Single center clinical data of patients who underwent PCI were retrospectively analysed to explore the predictive value of LVEDP for the occurrence of CIN. Results Among 1 301 patients who underwent PCI during the study period, 125 patients (9.61%) developed CIN. Risk factors for CIN included age, female, chronic kidney disease, history of diabetes mellitus, anemia, heart failure and emergencies in our study cohort. Compared with non-CIN group, the average LVEDP was higher in patients with CIN after PCI ((18.4±8.7) mmHg vs (14.4±6.6) mmHg, P<0.001). Multiple regression analysis showed that LVEDP (≥20 mmHg) could independently predict the occurrence of CIN (OR 1.6,5%CI 1.08~1.47). The predictive value of LVEDP for CIN was enhanced in patients with low ejection fraction. Contrast dosage in high-risk patients determined by elevated LVEDP was comparable to that in patients not found. Conclusions LVEDP is an independent predictor for CIN. Patients with elevated LVEDP (≥20 mmHg) are at higher risk of CIN after PCI. In CIN prevention, high-risk patients defined by elevated LVEDP need to be noticed by clinicians.

    参考文献
    [1] McCullough PA, Wolyn R, Rocher LL, et al.Acute renal failure after coronary intervention:incidence, risk factors, and relationship to mortality.Am J Med, 7,3(5):368-375.
    [2] Mehran R, Aymong ED, Nikolsky E, et al.A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention:development and initial validation.J Am Coll Cardiol, 4,4(7):1393-1399.
    [3] Marenzi G, Lauri G, Assanelli E, et al.Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction.J Am Coll Cardiol, 4,4(9):1780-1785.
    [4] Khwaja A.KDIGO clinical practice guidelines for acute kidney injury.Nephron Clin Pract, 2,0(4):c1791-1784.
    [5] Cockcroft DW, Gault MH.Prediction of creatinine clearance from serum creatinine.Nephron, 6,6(1):31-41.
    [6] Fahling M, Seeliger E, Patzak A, et al.Understanding and preventing contrast-induced acute kidney injury.Nat Rev Nephrol, 7,3(3):169-180.
    [7] Abe D, Sato A, Hoshi T, et al.Clinical predictors of contrast-induced acute kidney injury in patients undergoing emergency versus elective percutaneous coronary intervention.Circ J, 4,8(1):85-91.
    [8] Kern MJ, Christopher T.Hemodynamic rounds series II:the LVEDP.Cathet Cardiovasc Diagn, 8,4(1):70-74.
    [9] Braunwald E, Ross J.The ventricular end-diastolic pressure.Appraisal of its value in the recognition of ventricular failure in man.Am J Med, 3,4:147-150.
    [10] Forrester JS, Diamond G, Parmley WW, et al.Early increase in left ventricular compliance after myocardial infarction.J Clin Invest, 2,1(3):598-603.
    [11] Planer D, Mehran R, Witzenbichler B, et al.Prognostic utility of left ventricular end-diastolic pressure in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.Am J Cardiol, 1,8:1068-1074.
    [12] Bagai A, Armstrong PW, Stebbins A, et al.Prognostic implications of left ventricular end-diastolic pressure during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction:findings from the assessment of pexelizumab in acute myocardial infarction study.Am Heart J, 3,6(5):913-919.
    [13] Kobayashi A, Misumida N, Fox JT, et al.Prognostic value of left ventricular end-diastolic pressure in patients with non-ST-segment elevation myocardial infarction.Cardiol Res 5,6(4-5):301-305.
    [14] Nagendran J, Norris CM, Appoo JJ, et al.Left ventricular end-diastolic pressure predicts survival in coronary artery bypass graft surgery patients.Ann Thorac Surg, 4,7(4):1343-1347.
    [15] Andreucci M, Faga T, Pisani A, et al.Acute kidney injury by radiographic contrast media:pathogenesis and prevention.Biomed Res Int, 4,4:362725.
    [16] Gu G, Xing H, Zhou Y, et al.Inverse correlation between left ventricular end-diastolic pressure and contrast-induced nephropathy in patients undergoing percutaneous coronary intervention.Clin Exp Nephrol, 8,2(4):808-814.
    [17] Du LJ, Dong PS, Jia JJ, et al.Association between left ventricular end-diastolic pressure and coronary artery disease as well as its extent and severity.Int J Clin Exp Med, 5,8(10):18673-18680.
    [18] Davenport MS, Cohan RH, Ellis JH.Contrast media controversies in 2015:imaging patients with renal impairment or risk of contrast reaction.AJR Am J Roentgenol, 5,4(6):1174-1181.
    [19] Ugur M, Uluganyan M, Ekmekci A, et al.Combination of hemoglobin and left ventricular ejection fraction as a new predictor of contrast induced nephropathy in patients with non-ST elevation myocardial infarction.Med Sci Monit, 4,0:967-973.
    [20] Bartholomew BA, Harjai KJ, Dukkipati S, et al.Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification.Am J Cardiol, 4,3:1515-1519.
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吴广志,刘长青,张琦,王金艳,郑文成,邸亚丽,于佳新,陈超,郑宏伟,孙建华.左心室舒张期末压对冠状动脉介入术后患者造影剂肾病的预测价值[J].中国动脉硬化杂志,2019,27(10):874~880.

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  • 收稿日期:2018-12-18
  • 最后修改日期:2019-03-25
  • 在线发布日期: 2019-09-19