摘要
【目的】分析下肢动脉造影和经皮腔内血管成形术后患者对比剂肾病的发生率和相关危险因素,探讨糖尿病下肢动脉病变患者接受此项检查和治疗的肾安全性。【方法】2010年2月至2010年7月在中国中医科学院西苑医院血管外科行下肢动脉造影检查或/和腔内血管成形术治疗的连续性病例141例,分为糖尿病(n=91)和非糖尿病(n=50)组。记录患者一般资料及术中对比剂用量,测定术前血红蛋白浓度、血糖、血脂谱和血肌酐水平以及术后48 h血肌酐水平。采用独立样本t检验、卡方检验和多因素logistic回归模型进行统计分析。【结果】糖尿病组患者比非糖尿病组患者年龄大[分别为(71±9)和(63±17)岁,P=0.003]、血红蛋白浓度低[分别为(124±20)和(134±25)g/L,P=0.016]。在糖尿病组,基线肾功能减退亚组患者的对比剂用量比肾功能正常亚组少[分别为(48±15)和(57±18)mL,P=0.039)]。糖尿病组患者对比剂肾病的发生率与非糖尿病组患者相比无统计学差异(分别为7.7%和2.0%,P=0.260)。Logistic回归分析表明:血红蛋白浓度是对比剂肾病发生的独立危险因素(B=-0.075,OR=0.928,95%CI为0.868～0.991,P=0.026)。【结论】采用有效预防措施、控制对比剂用量,可能降低糖尿病患者下肢动脉造影和经皮腔内血管成形术后对比剂肾病发生的危险。糖尿病患者血红蛋白浓度降低,后者是对比剂肾病发生的独立危险因素,应该予以纠正。
【Objective】 To investigate the incidence of and risk predictive factors for contrast induced nephropathy（CIN） following lower extremity percutaneous transluminal angioplasty（PTA）,and to evaluate the renal safety of this examination or treatment in diabetic patients with lower extremity arterial disease.【Methods】 From February to July in 2010,141 consecutive patients who underwent lower extremity PTA were analyzed retrospectively.All patients were divided into diabetic group（n = 91） or non-diabetic group（n=50）.Demographic characteristics and the total volume of injected contrast medium were recorded.Baseline characteristics including the levels of hemoglobin,fasting plasma glucose,lipid profile,serum creatinine,as well as the serum creatinine level at 48 h after angioplastic procedure were measured.Independent t-test,chi-squre test and logistic regression model were applied.【Results】 The age was higher in diabetic group than that in non-diabetic group [（71 ± 9） vs（63 ± 17） years,P = 0.003],while the hemoglobin level was lower in diabetic group than that in non-diabetic group [（124 ± 20） vs（134 ± 25） g/L,P = 0.016].In diabetic patients,the volume of contrast medium was lower in the subgroup of impaired renal function than that in the normal renal function group [（48 ± 15） vs（57 ± 18） mL,P = 0.039].The incidence of CIN was no significant difference between diabetic and non-diabetic groups（7.7% vs 2.0%,P = 0.260）.Logistic regression demonstrated that hemoglobin level was an independent predictor of CIN（B =-0.075,OR = 0.928,95%CI： 0.868 ～ 0.991,P = 0.026）.【Conclusions】 Taking effective prophylaxis and restricting contrast medium volume,may reduce the risk of CIN in diabetic patients after angioplastic procedure.Decreased hemoglobin level,an independent predictor of CIN,has been shown in diabetic patients,and should be corrected.
出处
《中山大学学报（医学科学版）》
CAS
CSCD
北大核心
2011年第5期659-663,共5页
Journal of Sun Yat-Sen University:Medical Sciences
基金
广东省自然科学基金重点资助项目(10251008901000010)
作者简介
刘丹，博士，主治医师，研究方向：糖尿病外周血管病变，E-mail：danliu66@gmail．com；
通信作者：严励，教授，研究方向：糖尿病慢性并发症，E-mail：hfxyl@163．net
