房颤冷冻消融一站式术后对比剂肾病的发生率及危险因素分析

Incidence and Risk Factors of Contrast-Induced Nephropathy in Atrial Fibrillation Patients after “One-Stop” Procedure as Cryoballoon Ablation Combination with Left Atrial Appendage Closure

摘要: 目的：研究肾功能正常或轻度损害[估算肾小球内生肌酐清除率(eGFR) ≥ 60 ml/(min•1.73 m²)]的心房颤动(房颤)患者行冷冻消融一站式手术后对比剂肾病(CIN)的发生率，并进一步分析CIN发生的相关危险因素。方法：选取2019年6月至2022年6月在上海市松江区中心医院心内科行房颤冷冻导管消融一站式手术(房颤冷冻消融及左心耳封堵一站式手术) eGFR ≥ 60 ml/(min•1.73 m²)的患者64例，计算手术前后eGFR值；并依据对比剂肾病定义[血清肌酐值较基线期水平升高 ≥ 0.3 mg/dl (26.5 μmol/L)或达到基线期水平的1.5倍以上]将64例术后患者分为对比剂肾病组(n = 6)和非对比剂肾病组(n = 58)，记录所有患者的基线资料包括实验室指标、手术指标及估算的eGFR值。结果：房颤冷冻消融一站式术后eGFR水平较术前有显著降低(P < 0.05)。64例房颤患者冷冻导管消融一站式术后6例发生对比剂肾病，发生率为9.4%。二元Logistic回归分析显示，术前N末端前体脑利钠肽(NT-proBNP)水平(OR = 15.205, 95% CI: 1.082~213.646)是对比剂肾病发生的独立危险因素。结论：肾功能正常或轻度损害的房颤患者冷冻导管消融一站式术后可能出现急性肾功能损伤；房颤冷冻消融一站式术前高水平NT-ProBNP可能是患者术后发生对比剂肾病的独立危险因素。

Abstract: Objective: To evaluate incidence and the risk factors of contrast-induced nephropathy (CIN) in atrial fibrillation (AF) patients with normal or slightly impaired renal function (eGFR ≥ 60ml/min•1.73m²) after the one-stop procedure combination with cryoballoon ablation and left atrial appendage closure (LAAC) (“one-stop” procedure). Methods: We included a total of 64 patients with AF and normal or slightly impaired renal function (eGFR ≥ 60ml/min•1.73m²) underwent “one-stop” pro-cedure in the Shanghai Songjiang District Central Hospital between June 2019 and June 2022. All patients were divided into 2 groups after “one-stop” procedure: CIN group, serum creatinine in-creased by 0.3 mg/dl (26.5 μmol/L) or elevated to 50% higher than the baseline, n = 6; Non-CIN group, n = 58. The basic condition with laboratory tests, operative indexes were recorded and eGFR values were calculated in all patients. Results: The figure of eGFR after “one-stop” procedure was significantly lower than that before surgery (P < 0.05). CIN occurred in 6 patients after “one-stop” procedure and the incidence of CIN was 9.4% (6/64). Bivariate logistic regression analysis indicated that increased serum level of NT-proBNP before surgery (OR = 15.205, 95% CI: 1.082~213.646) was independent risk factor of CIN after “one-stop” procedure. Conclusions: Acute renal function injury may occur after “one-stop” procedure in AF patients with normal or slightly impaired renal function. The elevated NT-proBNP level before surgery is probably an independent risk factor of CIN after “one-stop” procedure.