实用医学杂志 ›› 2020, Vol. 36 ›› Issue (20): 2834-2837.doi: 10.3969/j.issn.1006⁃5725.2020.20.018

• 药物与临床 • 上一篇    下一篇

不同剂量二甲双胍对行直接经皮冠状动脉介入治疗患者造影剂肾病发病率的影响

陈晓扬1 张曦元1 姚姗姗1 钟毅2   

  1. 南宁市第一人民医院1老年病科综合病区，2 心血管内科（南宁530022）
  • 出版日期:2020-10-20 发布日期:2020-10-25
  • 基金资助:
    南宁市科学研究与技术开发项目计划项目（编号：20183040⁃3）

Effects of different doses of metformin on the incidence of contrast⁃induced nephropathy in patients under⁃going primary percutaneous coronary intervention

CHEN Xiaoyang*，ZHANG Xiyuan，YAO Shanshan，ZHONG Yi   

  1. Department of Geriatrics，the First People′s Hospital of Nanning，Nanning 530022，China
  • Online:2020-10-20 Published:2020-10-25

摘要：

目的 探讨不同剂量二甲双胍对急性心肌梗死（AMI）合并2 型糖尿病（T2DM）患者行直接经皮冠状动脉介入术后造影剂肾病（CIN）发病率的影响。方法 选取95例2017年1月至2019年12月在南宁市第一人民医院诊断为AMI 合并T2DM，且行直接经皮冠状动脉介入术（PCI）患者，并根据患者术前日常使用二甲双胍剂量分为低剂量组（二甲双胍≤ 1 000 mg/d）、高剂量组（二甲双胍> 1 000 mg/d）和对照组（术前术后未使用二甲双胍）。比较3 组临床资料的差异，应用Logistic 回归分析产生CIN 的危险因素。结果 3组在年龄、性别、BMI、心血管危险因素、冠脉造影情况、心血管用药、糖化血红蛋白、术前术后肌酐、肾小球滤过率（eGFR）方面比较差异无统计学意义（P > 0.05）；术后低剂量组出现CIN 7 例（21.9%），高剂量组8 例（26.7%），对照组7 例（20.6%），高剂量组发生率稍高，但3 组比较差异无统计学意义（P > 0.05）。Logistic 回归分析显示年龄> 75岁、术前eGFR < 60 mL/min 、造影剂用量≥ 150 mL是CIN的危险因素。结论 AMI 合并T2DM 患者行直接PCI 治疗，术前持续应用二甲双胍患者没有增加CIN 发病率；CIN发病率与年龄、eGFR、术中造影剂用量有关。

关键词: 急性心肌梗死, 2型糖尿病, 经皮冠状动脉介入术, 造影剂肾病

Abstract:

Objective To investigate the effect of different doses of metformin on the incidence of contrast⁃induced nephropathy（CIN）after primary percutaneous coronary intervention（PCI）in patients with acute myocardialinfarction（AMI）complicated and type 2 diabetes mellitus（T2DM）. Methods To select 95 patients between January2017 to December 2019 in The First People′s Hospital of Nanning diagnosis of AMI with T2DM，and all of themwere treated primary PCI. They were divided into low⁃dose group（metformin ≤ 1 000 mg/d），the high dose group（metformin > 1 000 mg/d）and the control group（non⁃metformin）according preoperatively. To compare threegroups of patients with clinical data and analyze the risk factors for CIN production by Logistic regression. Results There were no statistically significant differences among the three groups in age，sex，BMI，cardiovascular riskfactors，coronary angiography，cardiovascular medication，hemoglobin a1c（HbA1c），baseline and postoperativecreatinine，estimated glomerular filtration rate（eGFR）（all P > 0.05）. CIN occurred in 7 cases（21.9%）of the low⁃dose group，8 cases（26.7%）of the high⁃dose group，and 7 cases（20.6%）of the control group. The incidencewas slightly higher in the high⁃dose group，but there was no statistically significant difference among three groups（P > 0.05）. Logistic regression analysis showed that age of > 75 years old，preoperative eGFR < 60 mL/min，andcontrast media volum of ≥ 150 mL were risk factors of CIN. Conclusion Patients with AMI and T2DM were treatedprimary PCI，continuous use of metformin by therapeutic doses in preoperative did not increase the incidence ofCIN. The incidence of CIN was not related to the dose of metformin，but to age，eGFR，and contrast media volume.

Key words: acute myocardial infarction, type 2 diabetes mellitus, percutaneous coronary interven?tion, contrast?induced nephropathy

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