造影剂肾病.pptVIP

主要终点： PCI术前大剂量立普妥治疗显著降低CIN发生率 立普妥组 安慰剂组 立普妥组 安慰剂组 对比剂肾病发生率 (%) 0 3 6 9 12 15 P=0.046 5 13.2 Am J Cardiol, 2011 online 次要终点术前后Scr水平升高，立普妥组显著低于安慰剂组 围术期Scr水平 Scr（mg/dl） P=0.96 P=0.01 术后Scr自基线变化百分比 % P=0.024 立普妥 安慰剂 Am J Cardiol, 2011 online ARMYDA-CIN研究：PCI术前立普妥治疗是降低CIN风险的独立预测因子 发生CIN的OR 0 1 3 6 9 12 OR (95% CI) P 4.4 (1.2-15.7) 4.0 (1.2-13.1) 1.6 (0.51-4.8) 0.34 (0.12-0.97) 0.043 0.43 0.022 0.023 年龄65岁 造影剂用量超过最大值 造影剂负荷 立普妥 Multivariable Analysis Am J Cardiol, 2011 online ARMYDA-CIN的临床意义 PCI术前高剂量立普妥治疗显著降低CIN风险 1 立普妥组CIN风险显著降低66%，NNT=12 (每治疗12个患者即能预防1人发生CIN) 该研究中包括25-30%糖尿病患者 (常合并肾功能不全)，故立普妥对CIN的预防作用更具有临床价值 PCI术前高剂量立普妥治疗显著缩短住院时间 2 立普妥组2.9±0.9天 vs 安慰剂组 3.2±0.8天 (P=0.007) 该研究结果进一步支持PCI术前应尽早启动高剂量立普妥治疗 小 结 CIN是临床的常见问题, 应该高度重视并给予积极的预防干预策略 目前认为有效的策略包括 等渗盐水水化 尽量限制造影剂剂量 应用等渗或低渗造影剂 使用造影剂前数天停服肾毒性药物 药物预防如他汀类、乙酰半胱氮酸等可有效预防CIN 的发生, 但仍需进一步研究 谢 谢！ * 对比剂AKI的病理生理学学说 由于肾单位量减少，残留的肾单位易受到损伤，碘对比剂在导致短暂（几分钟）的血管舒张后，会导致持续的（几小时或几天）肾脏内血管收缩和缺血性损伤。缺血性损伤会导致氧化应激，从而产生一系列不良反应，导致肾小管细胞死亡。如果有足够量的肾单位损伤，就会发生血清肌酐显著升高。 * * The incidence of both mortality and ESRD increased in a graded manner with greater severity of AKI (P for trend 0.001 for both outcomes). The cumulative incidence of all-cause hospitalization exceeded 40% regardless of AKI status and did not increase in a graded manner with greater severity of AKI (P for trend0.137). * * In patients with chronic renal insuf?ciency, further decline in renal function (DRF) after percutaneous coronary intervention (PCI) is accompanied not only by adverse in-hospital events but also by increased risk of mortality and myocardial infarction at 1 year. This analysis was undertaken to determine if patients with normal renal function who develop DRF after PCI have a comparable increase in risk of death and myocardial infarction at 1 year, and whether this risk is independent of in-hospital complications (death, myocardial infarction, urgent coronary artery bypass grafting). We performed a retrospective analysis of all patients from a single center who