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目的:探讨冠心病患者PCI术后发生对比剂肾病(Contrast Media Induced Nephropathy,CIN)的预测因素。方法:入选2015年1月至2015年9月长海医院确诊为冠心病并接受PCI治疗的≥75岁老年患者共计317例,根据CIN评分分成CIN评分低分组(4-10分)、CIN评分中分组(11-16分)、CIN评分高分组(≥16分),分析比较不同CIN评分组患者的术后对比剂肾病的发生情况;对相关危险因素进行单因素及多因素分析,探讨冠心病PCI患者发生对比剂肾病的独立预测因子。结果:317例冠心病PCI患者中,14例发生CIN(4.4%),CIN评分高分组比例最高(4例,11.8%,P=0.042)。单因素分析表明,CIN风险评分、术前GFR、术前肌钙蛋白、术前总胆固醇、急性心肌梗死、Syntax评分在术后CIN发生中存在显著的统计学差异(P<0.05),为独立的风险预测因素。多因素Logistic回归分析结果显示,CIN风险评分在术后CIN发生中存在显著的统计学差异(95%CI:1.37-7.78,P<0.05),术前GFR在术后CIN发生中存在显著的统计学差异(95%CI:1.01-1.07P<0.05),两者均为独立预测因子。结论:CIN风险评分、术前GFR是高龄冠心病患者PCI术后发生CIN的独立预测因子。
Objective: To investigate the predictors of Contrast Media Induced Nephropathy (CIN) after PCI in patients with coronary heart disease. METHODS: A total of 317 elderly patients ≥75 years old from Changhai Hospital who were diagnosed with coronary heart disease and received PCI from January 2015 to September 2015 were divided into four groups according to the CIN score: low score of CIN (4-10), middle score of CIN (11-16 points), CIN score (≥16 points), analyze and compare the incidence of contrast-induced nephropathy in patients with different CIN score; univariate and multivariate analysis of related risk factors to explore the relationship between coronary heart disease Independent predictors of contrast-induced nephropathy in PCI patients. Results: Of the 317 patients with coronary artery disease, 14 had CIN (4.4%) and the highest CIN score (4 patients, 11.8%, P = 0.042). Univariate analysis showed that there was significant difference (P <0.05) between CIN risk score, preoperative GFR, preoperative troponin, preoperative total cholesterol, acute myocardial infarction and Syntax score in postoperative CIN Risk Predictors. Multivariate logistic regression analysis showed that there was a significant statistical difference in CIN risk score (95% CI: 1.37-7.78, P <0.05) between CIN risk score and postoperative CIN preoperative GFR Differences in learning (95% CI: 1.01-1.07 P <0.05), both independent predictors. Conclusion: The CIN risk score and preoperative GFR are independent predictors of CIN after PCI in elderly patients with coronary heart disease.