Abstract: Background Dapagliflozin is an effective drug for the treatment of type 2 diabetes mellitus（T2DM），which can also reduce the risk of nephropathy progression，decrease urinary protein and protect the heart. However，whether dapagliflozin can reduce the incidence of contrast-induced nephropathy（CIN）after percutaneous coronary intervention（PCI）in T2DM patients remain unclear. Objective To investigate the impact of dapagliflozin on the incidence of CIN in patients with T2DM underwent PCI. Methods According to the principle of 1:1 propensity matching based on the use of dapagliflozin，a total of 484 T2DM patients who underwent PCI in the Department of Cardiology，Tianjin Chest Hospital from January 2021 to December 2023 were retrospectively consecutively enrolled in the study，of which 242 cases were in the dapagliflozin group and 242 cases were in the control group. The pre-PCI clinical data of the two groups were collected and compared，and the renal functions of the two groups were recorded before PCI，48 hours after PCI and 1 week after PCI，including blood urea nitrogen（BUN），serum creatinine（Scr），creatinine clearance rate（Ccr），cystatin C（Cys-C），β-2 microglobulin（β2-MG），and neutrophil gelatinase associated apolipoprotein（NGAL）. The primary study endpoint was the incidence of CIN，and the secondary study endpoint was the change in renal function during the perioperative period of PCI. Multivariate Logistic regression was used to analyze the effect of dapagliflozin on the incidence of CIN after PCI in patients with T2DM. Results The incidence of CIN in patients in the dapagliflozin group was 6.2% lower than that in patients in the control group（12.0%）. The difference was statistically significant（χ2 =4.900，P=0.039）. The CIN risk score and B-type natriuretic peptide of patients in the dapagliflozin group were higher than those in the control group（P<0.05）. There was no statistically significant difference in BUN，Scr，Ccr，Cys-C，β2-MG，and NGAL levels between 2 groups before and 1 week after PCI（P>0.05）. At 48 hours after PCI，the levels of Cys-C，β2-MG，and NGAL in the dapagliflozin group were lower than those in the control group（P<0.05）. Multivariate Logistic regression analysis showed that high CIN risk score（OR=1.213，95%CI=1.085~1.358，P=0.001）and B-type natriuretic peptide levels（OR=0.338，95%CI=1.479~10.494，P=0.006）were independent risk factors for CIN after PCI in patients with T2DM，and the use of dapagliflozin （OR=0.338，95%CI=0.159~0.717，P=0.005） was an independent protective factor for the development of CIN after PCI in patients with T2DM. Conclusion The use of dapagliflozin is an independent protective factor against the development of CIN after PCI in patients with T2DM，and dapagliflozin does not increase the risk of developing acute kidney injury（AKI）after PCI in patients with T2DM and may reduce the incidence of CIN.

Key words: Diabetes mellitus, type 2；Acute kidney injury；Dapagliflozin；Contrast materials；Percutaneous coronary intervention；Root cause analysis

摘要： 背景 达格列净是治疗2型糖尿病（T2DM）的有效药物，还具有降低T2DM肾病进展风险、减少尿蛋白以及心脏保护等作用，然而，达格列净能否降低T2DM患者经皮冠状动脉介入治疗（PCI）术后对比剂肾病（CIN）发生率，目前尚不完全清楚。目的 探讨达格列净对T2DM患者PCI术后CIN发病的影响。方法 根据达格列净使用情况以1:1倾向性匹配原则，回顾性连续纳入2021年1月—2023年12月于天津市胸科医院心内科行PCI治疗的T2DM患者共484例为研究对象，其中达格列净组242例，对照组242例。收集2组患者PCI术前的临床资料并比较，同时记录2组患者PCI术前、PCI术后48h及PCI术后1周的肾功能，包括血尿素氮（BUN）、血清肌酐（Scr）、肌酐清除率（Ccr）、胱抑素-C（Cys-C）、β-2微球蛋白（β2-MG）、中性粒细胞明胶酶相关载脂蛋白（NGAL）的变化。主要研究终点为CIN发病率，次要研究终点为PCI围术期肾功能的变化。采用多因素Logistic回归分析达格列净对T2DM患者PCI术后CIN发病的影响。结果 达格列净组患者CIN发病率为6.2%低于对照组患者的CIN发病率（12.0%），差异有统计学意义（χ2=4.900，P=0.039）；达格列净组患者CIN危险评分及B型钠尿肽高于对照组（P<0.05）。PCI术前、术后1周，2组患者BUN、Scr、Ccr、Cys-C、β-2MG、NGAL水平比较，差异均无统计学意义（P>0.05）。PCI术后48h，达格列净组患者Cys-C、β-2MG、NGAL水平低于对照组（P<0.05）。多因素Logistic回归分析结果显示，CIN危险评分高（OR=1.213，95%CI=1.085~1.358，P=0.001）、B型钠尿肽水平升高（OR=0.338，95%CI=1.479~10.494，P=0.006）是T2DM患者PCI术后CIN发病的独立危险因素，使用达格列净（OR=0.338，95%CI=0.159~0.717，P=0.005）是T2DM患者PCI术后CIN发病的独立保护因素。结论 使用达格列净是T2DM患者PCI术后CIN发病的独立保护因素，达格列净并不增加T2DM患者PCI术后急性肾损伤（AKI）的发病风险，并可能降低CIN的发生率。

关键词: 糖尿病, 2型；急性肾损伤；达格列净；对比剂；经皮冠状动脉介入治疗；影响因素分析