郑瑜,李树仁,刘肖,张一峰

• 1:河北医科大学研究生学院
• 2:河北省人民医院心血管内科
• 3:河北北方学院研究生学院

摘要(Abstract)：

目的探讨ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PPCI)术后发生急性肾损伤(AKI)的危险因素,并分析其对住院期间并发症及死亡率的影响。方法回顾性分析2016年12月至2018年8月于河北省人民医院行PPCI的286例STEMI患者,根据是否发生AKI,分为AKI组(27例)和非AKI组(259例),分析人口学特征、临床资料及住院期间并发症,并对发生AKI的影响因素进行logistic多因素向后逐步回归法分析。结果STEMI患者PPCI术后AKI的发生率为9.4%。术中对比剂剂量AKI组虽大于非AKI组[(162.4±68.4)ml比(151.3±62.2)ml,P=0.339],但差异无统计学意义。AKI组在住院期间心力衰竭(59.3%比19.7%,P<0.001)、医院获得性感染(48.1%比21.6%,P=0.002)、出血并发症(11.1%比1.9%,P=0.031)及院内死亡率(44.4%比0.4%,P<0.001)显著高于非AKI组,差异均有统计学意义。经过共线性诊断排除自变量间的强共线性后,logistic多因素回归分析显示,脑血管病史(OR 8.896, 95%CI 2.310～34.264,P=0.001)、无复流/慢血流(OR 6.033,95%CI1.066～34.156,P=0.042)、左心室射血分数(LVEF)<50%(OR5.696,95%CI1.636～19.832,P=0.006)、主动脉内球囊反搏(IABP)(OR9.218,95%CI1.860～45.683,P=0.007)、对比剂剂量/肾小球滤过率比值增大(OR1.861,95%CI 1.338～2.589,P<0.001)、尿酸升高(OR1.009,95%CI1.003～1.016,P=0.005)、血红蛋白降低(OR0.966,95%CI0.937～0.997,P=0.030)是PPCI术后STEMI患者发生AKI的独立危险因素。结论 LVEF<50%、应用IABP、术后无复流/慢血流、脑血管病史、对比剂剂量/肾小球滤过率比值增大、尿酸升高、血红蛋白降低是STEMI患者并发AKI的独立危险因素;STEMI患者并发AKI住院不良事件发生率及死亡率显著升高。

关键词(KeyWords)： 急性肾损伤;ST段抬高型心肌梗死;直接经皮冠状动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 郑瑜,李树仁,刘肖,张一峰

参考文献(References)：

• [1] Marenzi G, Cosentino N, Bartorelli AL. Acute kidney injury in patients with acute coronary syndromes. Heart,2015,101(22):1778-85.
• [2]陈汉川，何浩铭，何晨，等.对比剂诱导急性肾损伤精细化预防策略的研究进展.中国介入心脏病学杂志，2019,27(12):711-714.
• [3] Kellum JA,Lameire N,Aspelin P, et al. Kideny disease:Improving global outcomes(KDIGO)acute kidney injury work group clinical practice guideline for acute kidney injury. Kidney Inter Suppl,2012,2(1):1-138.
• [4] Schmucker J, Fach A, Becker M, et al. Predictors of acute kidney injury in patients admitted with ST-elevation myocardial infarction–results from the Bremen STEMI-Registry. Eur Heart J Acute Cardiovasc Care,2018,7(8):710-722.
• [5] Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention:development and initial validation. J Am Coll Cardiol,2004,44(7):1393–1399.
• [6] Shacham Y, Leshem-Rubinow E, Gal-Oz A, et al. Association of Left ventricular function and acute kidney injury among ST-elevation myocardial infarction patients treated by primary percutaneous intervention. Am J Cardiol, 2015, 115(3):293-297.
• [7] Sinkovi?A, Masnik K, Mihevc M. Predictors of acute kidney injury(AKI)in high-risk ST-elevation myocardial infarction(STEMI)patients:A single-center retrospective observational study.Bosn J Basic Med Sci,2019,19(1):101-108.
• [8]李红，贾若飞，孟帅，等.主动脉内球囊反搏辅助经皮冠状动脉介入治疗急性冠状动脉综合征合并心源性休克患者的特征及预后分析.中国介入心脏病学杂志，2017,25(3):121-126.
• [9]李凤丽，任法新，董梅，等.估算肾小球滤过率与急性ST段抬高型心肌梗死患者心肌无复流的相关性研究.中国循环杂志，2016, 31(11):1064-1068.
• [10] Nikolsky E, Mehran R, Lasic Z, et al. Low hematocrit predicts contrast-induced nephropathy af ter percutaneous coronary interventions. Kidney Inter, 2005, 67(2):706-713.
• [11] Shacham Y, Gal-Oz A, Leshem-Rubinow E, et al. Association of admission hemoglobin levels and acute kidney injury among myocardial infarction patients treated with primary percutaneous intervention. Can J Cardiol, 2015, 31(1):50-55.
• [12] Kang MW,Chin HJ, Joo KW, et al. Hyperuricemia is associated with acute kidney injury and all-cause mortality in hospitalized patients. Nephrology(Carlton),2019,24(7):718-724.
• [13] Mora-Ramírez M, Estevez-Garcia IO, Irigoyen-Camacho ME,et al. Hyperuricemia on admission predicts short-term mortality due to myocardial infarction in a population with high prevalence of cardiovascular risk factors. Rev Invest Clin,2017,69(5):247-253.
• [14] Shacham Y, Steinvil A, Arbel Y. Acute kidney injury among ST elevation myocardial infarction patients treated by primary percutaneous coronary intervention:a multifactorial entity. J Nephrology, 2016, 29(2):1-6.
• [15] Khoury S,Margolis G,Rozenbaum Z,et al. Acute renal impairment in older adults treated with percutaneous coronary intervention for ST-segment elevation myocardial infarction. Coron Artery Dis,2019,30(8):564-568.
• [16] Margolis G, Gal-Oz A, Letourneau-Shesaf S, et al. Acute kidney injury based on the KDIGO criteria among ST elevation myocardial infarction patients treated by primary percutaneous intervention. J Nephrology, 2018,31(3):423-428.
• [17] Yu J, Philippe Généreux, Nikolsky E, et al. Contrast-induced acute kidney injury after primary percutaneous coronary intervention:results from the HORIZONS-AMI substudy. Eur Heart J, 2014, 35(1):1533-1540.
• [18] Caspi O, Habib M, Cohen Y, et al. Acute kidney injury after primary angioplasty:is contrast-induced nephropathy the culprit? J Am Heart Assoc, 2017, 6(6):e005715.
• [19] Mehran R, Rao SV, Bhatt DL, et al. Standardized bleeding de?nitions for cardiovascular clinical trials. Circulation, 2011, 123(23):2736-2747.
• [20] Mathews R, Peterson ED, Chen AY, et al. In-hospital major bleeding during ST-elevation and non-ST-elevation myocardial infarction care:derivation and validation of a model from the ACTION Registry?-GWTG?. Am J Cardiol,2011,107(8):1136-1143.
• [21] Nash MC, Strom JA, Pathak EB. Prevalence of major infections and adverse outcomes among hospitalized ST-elevation myocardial infarction patients in Florida, 2006. BMC Cardiovasc Disord, 2011,11(1):69.
• [22]周德兴，吴少芬，王金忠，等.彩色多普勒超声检查对重症感染急性肾损伤的诊断价值.中华医院感染学杂志，2019,29(17):2665-2668.