| Objective:To evaluate renal function impairment after percutaneous coronary stent implantation and to investigate its risk factors and protective factorsMethods:The study includes 313 patients who have underwent percutaneous coronary stent implantation between June 2017 to November 2017 in Zhongda Hospital,Southeast University.There were 208 cases of male patients and 105 cases of female patients.The cases were divided into 2 groups according to the follow-up results of renal function and its relationship with admission kidney function in three months:Renal function deterioration group(group A):the blood creatinine value increased by 44mmol/L or increased by 25%compared with the basic value and kidney function non-deteriorated group(group B).Then compare the clinical indicators of 2 groups.Results:There are 110 cases in group A and 203 cases in group B.There were no significant differences in age,blood routine examination,liver function,past medical history.Using SPSS 22.0 software and unconditioned Logistic regression(stepwise backwards method,P=0.05)can obtain:admission GFR,and the use of RAAS blocker after operation were associated with deterioration of renal function.The coefficient of partial regression were-0.623(OR 0.536,95%CI0.324~0.887 P=0.01),-0.021(OR 0.979,95%CI 0.971~0.987 P<0.001).In subgroup analysis,for the subjects with admission GFR were less than 90mL/(min·1.73m~2),there was a correlation between admission GFR,uric acid and the use of CCB after operation were associated with deterioration of renal function(P<0.05).High admission GFR and the use of calcium channel blockers after operation were protective factors,with partial regression coefficients of-0.560(OR0.571,95%CI 0.371-0.880 P=0.011)and-3.962(OR 0.019,95%CI 0.001-0.447P=0.014).High uric acid level was the risk factor,and the partial regression coefficient was 0.078(OR 1.074,95%CI 1.011-1.135 P=0.022).For the subjects whose GFR was greater than 90mL/(min·1.73m~2),there were significant differences in gender,admission GFR,serum glucose,number of lesion branches,emergency stent implantation,hydration,the use of RAAS blocker,calcium channel blockers and beta blocker after operation,which were correlated with the changes of renal function after operation(P<0.05).Admission GFR,the use of RAAS blocker and calcium channel blockers were associated with deterioration of renal function,which were used as protective factors.The coefficient of partial regression were-0.032(OR 0.968,95%CI 1.519~6.384 P=0.000),-1.605(OR 0.201,95%CI 0.089~0.455 P=0.000),-1.144(OR 0.319,95%CI 0.127~0.802 P=0.015).The subjects of female,admission serum glucose,number of diseased branches,emergency stent implantation,the use of beta receptor blockers were used as risk factors.The coefficient of partial regression were 1.136(OR 3.114,95%CI 1.519~6.384 P=0.002),0.222(OR 1.199,95%CI 1.059~1.319 P=0.007),1.465(OR 1.769,95%CI 1.406~1.910 P=0.002),2.092(OR 8.098,95%CI 3.114~21.058 P=0.000),1.733(OR 5.568,95%CI 1.568~17.428 P=0.003).Conclusion:1.Persistent renal insufficiency may still occur 3 months after iodine contrast agent injection.High admission GFR and the use of RAAS blocker after operation are protective factors for the occurrence of renal insufficiency.2.For the subjects with basic renal dysfunction,high admission GFR,the use of calcium channel blockers were the protective factors,and high uric acid level at admission was the risk factor.3.For the subjects with normal basic renal function,except the conclusion in 1,calcium channel blockers is the protective factor for the occurrence of renal insufficiency.Female,serum glucose,number of lesion branches,emergency stent implantation,and the use of beta blocker after operation are the risk factors for the occurrence of renal insufficiency. |
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