目的 探讨急性心肌梗死(AMI)患者行急诊经皮冠状动脉介入治疗(PCI)后对比剂肾病(CIN)的发生率、相关因素以及对预后的影响.方法 选择186例接受急诊PCI的急性ST段抬高心肌梗死患者,测定其术前和术后48～72 h内的血清肌酐水平(Scr),记录患者临床资料及住院期间发生的主要不良事件.CIN定义为术后48～72 h内Scr升高＞25%,或绝对值升高≥44.2 μmol·L-1(0.5 mg·dL-1).结果 186例患者中有34例发生CIN(CIN组),152例为非CIN(非CN组),CIN发生率为18.3%.CIN组患者年龄较非CIN组更大(P＜0.05),CIN组肾功能不全、左室射血分数(LVEF)<40%、合并心力衰竭(Killip≥Ⅱ级)的患者明显多于非CIN组(P＜0.01),所有心源性休克患者均发生了CIN;CIN组术前使用他汀类药物的患者比例低于非CIN组(P＜0.05).Logistic多因素回归分析显示,肾功能不全(基线肌酐清除率＜60 mL·min-1)、使用主动脉内球囊反搏(IABP)、心源性休克、术前他汀治疗与CIN的发生有关.CIN组患者的住院时间较非CIN组延长,住院期间主要不良事件发生率增高(P＜0.05或P＜0.01).结论 CIN是急诊PCI患者的常见并发症,可能增加住院期间不良事件的发生率.肾功能不全和血流动力学不稳定是CIN的危险因素,术前他汀治疗是减少CIN发生的预测因素.%Objective To investigate the incidence, clinical predictors and in-hospital outcome of contrast-induced nephropathy (CIN) in patients who underwent primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Methods Serum creatinine (Scr) con-centration was measured before and 48-72 hours after PCI in 186 patients with acute ST-segment elevation myocardial infarction. Clinical characteristics and adverse events were observed during hospitalization. CIN was defined as an increase in serum creatinine of > 25% or≥ 44. 2 μmol · L-1(0. 5 mg · dL -1)from baseline within 48-72 hours following the procedure. Re-sults Among the 186 patients,34 (18. 3%) developed CIN. Patients with CIN were more likely to be older(P<0. 05) and had higher incidences of pre-existing renal insufficiency, left ventricular ejection fraction (LVEF)<40 %, heart failure (Killip ' s class≥2) than those without CIN(P< 0. 01). All patients with cardiogenic shock developed CIN at admission. The percentage of patients who received pretreatment with statin in CIN group was lower than that in non-CIN group(P<0.05). Multivariate Logistic regression analysis revealed that renal insufficiency (baseline Cr clearance<60 mL · min-1), implantation of intra-aortic balloon pump(IABP) , cardiogenic shock and statin pretreatment were correlated with CIN. CIN group had longer hospital stay and more adverse events than non-CIN group(P<0. 05 or P<0. 01). Conclusion CIN frequently compli-cates primary PCI and is associated with higher incidence of in-hospital adverse events in patients with AMI. Pre-existing renal dysfunction and hemodynamic instability are the independent risk factors for CIN. Statin pretreatment is a predictor of decresed risk of CIN.
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