入院高血糖与急性心肌梗死患者心导管术后急性肾损伤的相关性  

Relation between admission glucose and risk of contrast-induced acute kidney injury in patients with acute myocardial infarction undergoing percutaneous coronary intervention

作　　者：孔繁宇[1] 邓家强[1] 廖志山 魏峥[1] 富蓉[1] 刘军明[1] 黄健安[1] 邓俊明 范志勇[1] 张琴[1] 

机构地区：[1]广东省佛山市南海区中医院心内科,广东佛山510080

出　　处：《岭南心血管病杂志》2015年第2期167-171,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的 探讨入院时高血糖与急性心肌梗死（acute myocardial infarction,AMI）患者经皮冠状动脉介入（percutaneous coronary intervention,PCI）治疗后发生对比剂诱导的急性肾损伤（contrast-induced acute kidney injury CI-AKI）的关系。方法 连续性入选2009年10月至2014年4月在广东省佛山市南海区中医院住院,拟行PCI治疗的AMI患者190例,分析发生和未发生CI-AKI两组患者的临床特点及其他院内不良事件。采用多因素Logistic回归分析探讨入院时高血糖与CI-AKI的关系。结果 190例患者中,25例发生CI-AKI（13.2%）,比未发生CI-AKI的患者具有更高的院内病死率（25%vs.3%,P〈0.001）。与未发生CI-AKI患者相比,发生CI-AKI患者的入院血糖较高[（2 220±1 050）mg/L vs.（1 660±690）mg/L,P〈0.001]。CI-AKI的发生率随着血糖的升高不断增加：血糖〈1 200 mg/L时发生率为7%;血糖在1 200~1 600 mg/L时为9%;在1 600~2000 mg/L为11%;血糖〉2 000 mg/L时为28%。多因素Logistic回归分析显示,经过年龄、基础肾功能、糖尿病等因素校正后,入院时高血糖仍然是CI-AKI的独立危险因素（OR=1.10;95%CI：1.03~1.18,P=0.02）。结论 入院时高血糖是AMI患者行PCI治疗后发生CI-AKI的危险因素,加强对入院时高血糖的认识与治疗,可能对减少这些患者发生CI-AKI具有重要的意义。Objectives To assess the relationship between admission glucose and incidence of contrast-induced acute kidney injury（CI-AKI） in patients with acute myocardial infarction（AMI） after percutaneous coronary intervention（PCI）. Methods A total of 190 consecutive patients with AMI undergoing PCI from October 2009 to April 2014 in Hospital of Traditional Chinese Medicine, Nanhai District, Foshan were enrolled. We examined the clinical characteristics,incidence of CI-AKI and other major adverse cardiac events in hospital. The relationship between CI-AKI and admission glucose was evaluated by multivariate Logistic regression analysis. Results There were 25 patients（13.2%） developed CI-AKI during hospitalization, who had a higher in-hospital mortality rate than those without CI-AKI（25% vs. 3%, P〈0.001）. Patients with CI-AKI had higher plasma glucose（PG） on admission than those without [（2 220 ±1 050） mg / L vs.（1 660±690） mg / L,P〈0.001 ]. The incidence of CI-AKI increased as admission PG rose ： 7% with PG1〈200 mg / L;9% with PG 1 200-1 600 mg / L;11% with PG 1 600-2 000 mg / L;and 28% with PG〉2 000 mg / L. After adjustment for potential co-variants（age, renal function, diabetes mellitus and so on） in multivariate Logistic regression analysis, PG remained an independent risk factor for CI-AKI（odds ratio =1.10; 95% confidence interval ：1.03-1.18,P =0.02）.Conclusions Admission hyperglycemia may have contributed to the development of CI-AKI in patients with AMI.Paying more attention to admission hyperglycemia may be useful for the prevention of CI-AKI.

关 键 词：心肌梗死 高血糖 血管成形术 经皮 经腔冠状动脉 急性肾损伤 

分 类 号：R542.22[医药卫生—心血管疾病]