术前血清尿酸浓度与急诊经皮冠状动脉介入治疗后对比剂肾病的关系  

Relationship of preoperative serum uric acid and contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention

作　　者：邓红胜[1] 孙喜文[1] 陈炎[1] 朱秀龙[1] 张灿[1] 邱国[1] 莫观海[1] 

机构地区：[1]广东高州市人民医院心内科,广东高州525200

出　　处：《岭南心血管病杂志》2015年第4期474-477,481,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨术前血清尿酸（serum uric acid,SUA）浓度与急性ST段抬高型心肌梗死（ST-segment elevation myocardial infarction,STEMI）患者急诊经皮冠状动脉介入（percutaneous coronary intervention,PCI）治疗后发生对比剂肾病（contrast-induced nephropathy,CIN）的关系。方法连续收集2010年8月至2014年10月于广东高州市人民医院住院,拟行急诊PCI治疗的STEMI患者186例,记录急诊SUA和肌酐浓度、PCI治疗48~72 h内肌酐浓度。比较发生CIN与未发生CIN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SUA与CIN的相关性。结果 186例患者中,CIN的发生率达23.1%（n=43）。与未发生CIN患者相比,发生CIN患者的SUA浓度明显较高,差异有统计学意义[（60.9±20.1）mg/L vs.（48.9±13.2）mg/L,P〈0.001]。单因素Logistic分析显示,SUA为CIN的危险因素（OR=1.61,95%CI：1.38~1.88,P〈0.001）。经校正相关因素的多因素Logistic分析显示,SUA仍然是CIN的独立危险因素（OR=1.32,95%CI：1.10~1.60,P=0.003）。同时,受试者工作曲线（receiver operating characteristic curve,ROC）显示,预测此类人群发生CIN的SUA最优值为50.5 mg/L（曲线下面积为0.685,P〈0.001;敏感性为74%;特异性为69%）。结论术前SUA浓度是STEMI患者行急诊PCI治疗后发生CIN的独立危险因素,早期检测SUA浓度有利于预防CIN的发生。Objectives To investigate the predictive role of serum uric acid（SUA） concentrations measured in the emergency department in monitoring contrast-induced nephropathy（CIN） in patients with ST-segment elevation myocardial infarction（STEMI） undergoing primary percutaneous coronary intervention（PCI）. Methods The STEMI patients who were admitted to Gaozhou People ＇s Hospital and underwent primary PCI from August 2010 to October 2014 were enrolled retrospectively. Their baseline characteristics including SUA and creatinine concentrations in the emergency department and their creatinine concentrations 48-72 hours after PCI were noted. Clinical data and adverse events in hospital between CIN patients and non-CIN patients were compared. Multiple Logistic regression analysis was used to define the independent predictors of CIN. Results Among the 186 patients, CIN was observed in 23.1%（n=43） patients.SUA concentration was significantly higher in CIN group compared with that in non-CIN group [（60.9 ± 20.1） mg / L vs.（48.9±13.2） mg / L, P〈0.001]. Univariate Logistic analysis demonstrated that SUA was a risk factor of CIN（OR=1.61,95% CI ： 1.38-1.88, P 〈0.001）. Multivariate Logistic analysis indicated that SUA was the independent risk predictor of CIN after adjustment of other potential risk factors（OR =1.32, 95% CI ： 1.10-1.60, P =0.003）. Receiver operating characteristic（ROC） curve showed that the cut-off value for SUA was 50.5 mg / L for the prediction of CIN（area under the ROC curve was 0.685,P〈0.001; sensitivity was 74%; specificity was 69%） in the population. Conclusions Preoperative SUA concentration is a simple independent early predictor of CIN in patients who underwent primary PCI,and early detection may help prevent the progression of CIN.

关 键 词：心肌梗死 对比剂肾病 尿酸 血管成形术 经腔 经皮冠状动脉 

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