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目的探讨低水平高密度脂蛋白胆固醇(HDL-C)与冠心病患者经皮冠状动脉介入治疗(PCI)后对比剂诱导的急性肾损伤(CI-AKI)的关系。方法 500例行PCI术的冠心病患者,依据HDL-C水平将其分为低水平HDL-C组(190例)和正常HDL-C组(310例),于术前及术后72 h内测定其血肌酐水平。应用多元Logistic回归分析确定CI-AKI及低水平HDL-C的危险因素。结果在500例行PCI术的冠心病患者中,共有79例(15.8%)发生了CI-AKI,低水平HDL-C组与正常HDL-C组的CI-AKI发病率分别为21.6%和12.3%(P<0.05)。进一步分析发现,伴有慢性肾脏疾病(CKD)者,CI-AKI发病率在低水平HDL-C组与正常HDL-C组分别为39.3%和27.3%(P<0.05),而在不伴有CKD者分别为17.8%和9.7%(P<0.05)。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发生的高危因素,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的高危因素,超重、吸烟及贫血是低水平HDL-C的预测因子。
Objective To investigate the relationship between low-level high-density lipoprotein cholesterol (HDL-C) and contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI) in patients with coronary heart disease. Methods 500 patients with coronary heart disease undergoing PCI were divided into low HDL-C group (190 cases) and normal HDL-C group (310 cases) according to the level of HDL-C, and preoperative and postoperative 72 h Determination of serum creatinine levels. Multiple logistic regression analysis was used to determine the risk factors for CI-AKI and low-level HDL-C. Results CI-AKI occurred in 79 patients (15.8%) in 500 patients with coronary artery disease. The incidences of CI-AKI in low HDL-C group and normal HDL-C group were 21.6% and 12.3 % (P <0.05). Further analysis showed that the incidence of CI-AKI was 39.3% and 27.3% (P <0.05) in patients with chronic kidney disease (CKD) and HDL-C at low levels CKD were 17.8% and 9.7% (P <0.05). Multivariate Logistic regression analysis showed that low-level HDL-C was a risk factor for CI-AKI after PCI in CHD patients. Overweight, smoking and anemia were the predictors of low-level HDL-C in these patients. Conclusions Low-level HDL-C is a risk factor for CI-AKI in patients with coronary artery disease after PCI, with or without chronic kidney disease. Overweight, smoking and anemia are predictors of low-level HDL-C.