卢鑫,黄雅青,孟浩宇,汪芸玏,陈彭生,程维礼,杨志健

• 1:南京医科大学第一附属医院心脏科
• 2:南京医科大学鼓楼临床医学院

摘要(Abstract)：

目的评估入院即刻血肌酸酐水平对接受急诊经皮冠状动脉介入治疗(PCI)ST段抬高心肌梗死(STEMI)患者的冠状动脉狭窄程度及预后的预测价值。方法分析接受急诊PCI的STEMI患者共1159例,根据入院即刻血肌酸酐水平四分位数分组,比较组间基线特征差异。采用Gensini评分系统对每位患者造影结果进行评分,用以衡量冠状动脉狭窄程度。应用Spearman双侧相关分析及多元线性回归分析研究Gensini评分与血肌酸酐的关系。采用单因素和多因素COX回归分析住院病死率的危险因素。结果入院血肌酸酐升高患者较正常者,年龄大、多为男性、吸烟,高血压发病率高。Spearman相关分析示血肌酸酐与Gensini评分显著正相关,但相关性较弱(r=0.125,P<0.001)。多元线性相关分析结果表明,血肌酸酐与冠状动脉狭窄程度的积分独立相关,其偏相关系数β=0.081,P=0.012。COX多元回归模型结果提示:入院时舒张压(HR=0.955,P=0.006)、血肌酸酐(HR=1.009,P=0.003)、中性粒细胞计数(HR=1.141,P=0.010)、Killip分级≥3级(HR=6.500,P=0.001)是接受急诊PCI的STEMI患者住院期间死亡的独立预测因素。结论入院即刻血肌酸酐与接受急诊PCI的STEMI患者冠状动脉狭窄独立相关。高血肌酸酐是STEMI住院期间预后的独立危险因素。

关键词(KeyWords)： 血肌酸酐;急性ST段抬高心肌梗死;Gensini评分;住院期间死亡率

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 卢鑫,黄雅青,孟浩宇,汪芸玏,陈彭生,程维礼,杨志健

参考文献(References)：

• [1]Gibson CM,Pinto DS,Murphy SA,et al.Association of creatinine and creatinine clearance on presentation in acute myocardial infarction with subsequent mortality.J Am Coll Cardiol,2003,42:1535-1543.
• [2]Walsh CR,O'Donnell CJ,Camargo CA Jr,et al.Elevated serum creatinine is associated with 1-year mortality after acute myocardial infarction.Am Heart J,2002,144:1003-1011.
• [3]Sadeghi HM,Stone GW,Grines CL,et al.Impact of renal insufficiency in patients undergoing primary angioplasty for acute myocardial infarction.Circulation,2003,108:2769-2775.
• [4]Cakar MA,Gunduz H,Vatan MB,et al.The effect of admission creatinine levels on one-year mortality in acute myocardial infarction.ScientificWorld Journal,2012,2012:186495.
• [5]叶飘,谭宁,陈纪言,等.中性粒细胞/淋巴细胞比值与急性心肌梗死患者行急诊经皮冠状动脉介入治疗术后对比剂肾病发生的相关性.中国介入心脏病学杂志,2014,22:84-88.
• [6]王云飞,李小明,薛淞,等.进口与国产药物洗脱支架治疗急性ST段抬高心肌梗死的预后分析.中国介入心脏病学杂志,2014,22:35-39.
• [7]Thygesen K,Alpert JS,White HD,et al.Universal definition of myocardial infarction.Circulation,2007,116:2634-2653.
• [8]Antman EM,Hand M,Armstrong P W,et al.2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines:developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians:2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction,Writing on Behalf of the 2004 Writing Committee.Circulation,2008,117:296-329.
• [9]Gensini GG.A more meaningful scoring system for determining the severity of coronary heart disease.Am J Cardiol,1983,51:606.
• [10]Pajunen P,Syvnne M,Nieminen MS,et al.Serum homocysteine,creatinine,and glucose as predictors of the severity and extent of coronary artery disease in asymptomatic members of high-risk families.Eur J Clin Invest,2002,32:472-478.
• [11]Ferrer-Hita JJ,Dominguez-Rodriguez A,Garcia-Gonzalez MJ,et al.Renal dysfunction is an independent predictor of in-hospital mortality in patients with ST-segment elevation myocardial infarction treated with primary angioplasty.Int J Cardiol,2007,118:243-245.
• [12]Schiele F,Legalery P,Didier K,et al.Impact of renal dysfunction on1-year mortality after acute myocardial infarction.Am Heart J,2006,151:661-667.
• [13]Rihal CS,Textor SC,Grill DE,et al.Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention.Circulation,2002,105:2259-2264.