陈永利 许静 刘园园 杨世诚 丛洪良 付乃宽

DOI：10.3760/cma.j.issn.1671-0282.2014.09.016

基金項目：天津市卫生局科技基金重点攻关项目（10KG122）

作者单位：300051 天津，天津市胸科医院心内科

通信作者：付乃宽，Email：drfnk2013@163.com

【摘要】目的 探讨低水平高密度脂蛋白胆固醇（high-density lipoprotein cholesterol， HDL-C）与冠心病患者经皮冠状动脉介入术（percutaneous coronary intervention， PCI）后对比剂诱导的急性肾损伤（contrast induced-acute kidney injury， CI-AKI）的关系。

方法 选取天津市胸科医院心内科2009年1月至2011年5月行PCI术的冠心病患者共1500例，于术前及术后72 h内测定其血肌酐水平。入选标准：均为汉族人群，年龄及性别不限；排除标准：既往有恶性肿瘤、泌尿系统感染、肾脏切除手术、腹膜或血液透析治疗或术前两周内曾应用过对比剂。CI-AKI定义为应用对比剂后24～72 h血清肌酐水平较原有基础升高超过25%或绝对值升高44.2 μmol/L以上，并排除其他影响肾功能的原因。低水平HDL-C定义为HDL-C< 1.04 mmol/L。应用单因素分析及多元Logistic回归分析确定CI-AKI及低水平HDL-C的危险因素。

结果 在1500例行PCI术的冠心病患者中，共有246例（16.4%）发生了CI-AKI，低水平HDL-C组与正常水平HDL-C组的CI-AKI发病率分别为21.5%和13.3%（P<0.01）。进一步分析发现，伴有慢性肾脏疾病者，CI-AKI发病率在低水平HDL-C组与正常水平HDL-C组分别为39.8% 和26.5%（P<0.05），而在不伴有慢性肾脏疾病者分别为9.7% 和17.7%（P<0.01），差异均具有统计学意义。多元Logistic回归分析显示，低水平HDL-C是冠心病患者PCI术后CI-AKI发生的危险因素，超重、吸烟及贫血是该类患者低水平HDL-C的预测因子。

结论 与HDL-C水平正常者相比，低水平HDL-C者PCI术后CI-AKI的发病率显著升高。无论是否伴有慢性肾脏疾病，低水平HDL-C均是冠心病患者PCI术后发生CI-AKI的危险因素。超重、吸烟及贫血是低水平HDL-C的预测因子。

【关键词】 高密度脂蛋白胆固醇；经皮冠状动脉介入治疗；急性肾损伤；对比剂

Low level of high-density lipoprotein cholesterol predicts contrast induced-acute kidney injury after percutaneous coronary interventions in patients with coronary heart disease

Chen Yongli，Xu Jing，Liu Yuanyuan，Yang Shicheng，Cong Hongliang， Fu Naikuan.Department of Cardiology，Tianjing Chest Hospital，Tianjing 300051，China

Corresponding author： Fu Naikuan， Email： drfnk2013@163.com

【Abstract】Objective To investigate the relationship of low level of high-density lipoprotein cholesterol to contrast induced-acute kidney injury（CI-AKI）after percutaneous coronary intervention （PCI） in patients with coronary heart disease.Methods A total of 1500 consecutive patients，who underwent PCI from January 2009 to May 2011，were enrolled in this study. There was no limit on age or sex， and all patients were self-identified as Han ethnic group. Patients were excluded from this study， however， if they had a history of malignant tumor， urinary tract infection， nephrectomy operation， chronic peritoneal or hemodialysis， or if they had been exposed to contrast media within the past 14 days. CI-AKI was defined as an absolute increase in serum creatinine ≥44.2 μmol/L or a relative ≥25% increase in serum creatinine within 72 hours after procedure. Low level of HDL-C was defined as <1.04 mmol/L. Monofactorial and multivariate analysis was performed to identify risk factors for CI-AKI and low level of HDL-C in these patients. Results Among the 1500 patients with coronary heart disease， CI-AKI occurred in 246 patients after PCI and the overall incidence of CI-AKI was 16.4%. The patients with low level of HDL-C had a higher incidence of CI-AKI than those without it（21.5% vs. 13.3% in total，P<0.01），no matter that they had suffered from chronic kidney disease（39.8% vs. 26.5%，P<0.05）or not（17.7% vs. 9.7%，P<0.01）. By multivariate analysis， low level of HDL-C was identified as an independent risk factor for CI-AKI and smoke， great BMI as well as anemia were considered as prediction factors for low level of HDL-C. Conclusion The patients with low level of HDL-C have a higher incidence of CI-AKI after PCI. Low level of HDL-C is one of risk factors for CI-AKI after PCI in patients either with chronic kidney disease or not. Great BMI，smoking as well as anemia are independent predictors for low HDL-C level in these patients.

【Key words】 High-density lipoprotein cholesterol； Percuta neous coronary intervention； Acute kidney injury； Contrast

对比剂诱导的急性肾损伤（contrast induced-acute kidney injury， CI-AKI）是指应用对比剂后24～72 h血清肌酐水平较原有基础升高超过25%或绝对值升高44.2 μmol/L以上，并排除其他影响肾功能的原因^[1]。文献报道，CI-AKI已成为继外科手术及药物之后院内获得性肾损害的第三大原因^[2]。一旦发生CI-AKI，患者的住院时间、住院费用、心脏不良事件及病死率将显著增加，生活质量也将受到严重影响^[3]。……