急性心肌梗死患者非手术相关性急性肾损伤  

Patients with acute kidney injury after acute myocardial infarction not associated with cardiac surgery

作　　者：孙妍蓓[1,2] 陶源[1,2] 邹芸[1,2] 杨敏[1,2] 

机构地区：[1]苏州大学附属第三医院 [2]常州市第一人民医院肾脏科,常州213000

出　　处：《肾脏病与透析肾移植杂志》2015年第1期11-15,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的：探讨急性心肌梗死（AMI）非手术相关性急性肾损伤（AKI）的危险因素. 方法：回顾性分析2008-12-01～2012-12-31在苏州大学附属第三医院诊断AMI后未行手术治疗发生AKI的患者及对照组人群资料共计656例,根据KDIGO指南推荐的标准定义AKI. 结果：AMI后非手术（包括冠脉造影术、冠脉搭桥术）治疗后发生的AKI共计228例（34.8％）,其病死率显著高于对照组（P＜0.001）.多因素Logistic回归分析结果：基线eGFR下降（OR=2.049,95％CI 1.246～3.370）、空腹血糖（FBG）升高（OR=1.070,95％CI 1.018～1.124）、利尿剂（OR=1.867,95％CI 1.220～ 2.856）和心肌梗死KillipⅣ级（OR=1.362,95％CI 1.059～3.170）是AKI患病的独立危险因素（P＜0.05）,入院时舒张压（DBP）增高（OR=0.986,95％CI 0.974～0.998）是AKI患病的保护性因素（P＜0.05）. 结论：住院AMI非手术治疗患者发生AKI的患病率、病死率较高.基础肾功能减退、空腹血糖增加、心功能下降及利尿剂为该人群患病的独立危险因素,基础舒张压水平升高为保护性因素.Objective：We performed a prospective, observational, single center cohort study to determine the rate, severity, risk-factors and characteristics of non-cardiac surgery associated acute kidney injury （AKI） in acute myocardial infarction （AMI） patients. Methodology： We retrospectively studied adult AMI patients hospitalized in teaching hospital, and started from January 2008, and completed in December 2012. There were a total of 1 655 AMI patients, and 1 371 were data completed. We chose patients as a group who developed AKI, neither after cardioangiography （CAG） nor coronary artery bypass grafting （CABG） , and its control group. In this study, AKI was defined according to KDIGO AKI criteria. Thus, 656 patients were enrolled in this study. The demographics, medical history, diagnosis and management of AMI, laboratory parameters and treatment before AKI of the patients with and without AKI were collected. Simple and multiple logistic regression models were used to evaluate independent risk factors of AKI. Results：They were 433 males and 223 females with a median age of 74 years. Among them, 228 （34. 8% ） developed AKI. Neither cardiac nor renal function was found better in the AKI group. After adjusting for gender and age, multifactor retrospective analysis showed that decreased baseline estimated glomerular filtration rate （eGFR） （adjusted odds ratio [ OR] = 2. 049, 95% confidence interval [ CI ] 1. 246- 3. 370, P = 0. 005）, increased fasting plasma glucose （FPG） （ adjusted OR = 1. 070, 95%CI 1. 018~ 1. 124, P= 0. 007）, diuretics （adjusted OR= 1. 867, 95%CI 1. 220-2. 856, P=0. 019） and Killip Grade 4 （adjusted OR = 1. 362, 95% CI 1. 059 ~ 3. 170, P = 0. 047） were independent risk factors of AKI, while increased diastolic blood pressure （DBP） on admission exhibited a lower adjusted OR value （adjusted OR = O. 986, 95%CI 0. 974- 0. 998, P = 0. 029 ）, for patients of AKI neither happened after CAG nor CABG. Conclusion.. AKI is a common complication and associat

关 键 词：急性心肌梗死 急性肾损伤 流行病学 患病率 

分 类 号：R542.22[医药卫生—心血管疾病] R692[医药卫生—内科学]