肾小球滤过率对急性心肌梗死患者直接经皮冠状动脉介入术后预后的影响  

Impact of Glomerular Filtration Rate on Prognosis in Patients with Aute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

作　　者：李其华[1] 韦金儒[1] 唐泉[1] 银剑斌[1] 蒋芳勇[1] 

机构地区：[1]广西柳州市人民医院心血管内科,545001

出　　处：《中国全科医学》2016年第36期4456-4460,共5页Chinese General Practice

摘　　要：目的研究肾小球滤过率对急性心肌梗死患者直接经皮冠状动脉介入术(PCI)后预后的影响。方法选取2011年6月—2013年7月柳州市人民医院心血管内科符合纳入标准的急性心肌梗死患者118例为研究对象。根据美国肾脏基金会制定的慢性肾脏病分期标准,将患者分为正常估算肾小球滤过率(e GFR)组〔e GFR≥90.0 ml·min^(-1)·(1.73 m^2)-1,56例〕和低e GFR组〔e GFR<90.0 ml·min^(-1)·(1.73 m^2)-1,62例〕。记录患者一般资料,包括性别、年龄、吸烟史、体质指数、高血压发生情况、糖尿病发生情况、血脂异常发生情况,入院血肌酐、心功能Killip分级、血清肌钙蛋白Ⅰ、e GFR以及入院3 d内左心室射血分数。记录冠状动脉造影结果〔梗死相关动脉(IRA)及冠状动脉病变情况(冠状动脉病变支数、是否合并左冠状动脉主干病变)〕。术后对所有患者进行随访,记录主要不良心血管事件(MACE)(包括靶血管血运重建、非致死性心肌梗死、心源性死亡)发生情况。结果两组性别、吸烟率、体质指数、高血压发生率、糖尿病发生率、血脂异常发生率、入院心功能Killip分级、入院血清肌钙蛋白Ⅰ、入院3 d内左心室射血分数比较,差异无统计学意义(P>0.05);正常e GFR组年龄小于低e GFR组,入院血肌酐低于低e GFR组(P<0.05)。两组梗死相关动脉(IRA)、冠状动脉病变支数、合并左冠状动脉主干病变发生率比较,差异无统计学意义(P>0.05)。两组靶血管血运重建、非致死性心肌梗死、心源性死亡发生率比较,差异无统计学意义(P>0.05);低e GFR组总MACE发生率高于正常e GFR组(P<0.05)。低e GFR组无MACE生存率低于正常e GFR组(P<0.05)。Cox比例风险回归模型分析结果显示,在校正其他因素影响后,年龄〔RR=1.564,95%CI(1.059,2.413)〕、糖尿病〔RR=3.916,95%CI(1.874,7.215)〕、e GFR下降〔RR=3.323,95%CI(1.452,6.820)〕是MACE的影响因素(P<0.05)。结论血肌酐处于参Objective To investigate the impact of glomerular filtration rate （GFR） on prognosis in patients with aute myocardial infarction （AMI） accepted primary percutaneous coronary intervention （PCI）. Methods A total of 118 AMI patients who were hospitalized in Department of Cardiology of Liuzhou General Hospital from June 2011 to July 2013 and met inclusion criteria were enrolled in the study. They were divided into normal estimated glomerular filtration rate （ eGFR ） group [eGFR≥90.0ml. min-1 （1.73 m2）-1, n=567 and low eGFR group [eGFR〈90.0 ml· min-1 ·（1.73 m2）-j, n = 62 ] according to chronic kidney disease classification issued by the National Kidney Foundation. The general characteristics including gender, age, smoking, body mass index, hypertension, diabetes mellitus, hyperlipidemia, serum creatinine, Killip class, serum cardiac troponin I and eGFR on admission, and left ventricular ejection fraction in 3 d were recorded. Results of coronary angiography including infarct related artery （IRA） and coronary artery disease （ number of coronary artery disease, and whether combined left main coronary artery disease ） were recorded. All the patients were given regular follow - up after PCI. Incidence of major cardiovascular events （MACE） including target vessel revascularization, non - fatal myocardial infarction and cardiac death was observed. Results There was no statistically significant difference in gender, smoking, body mass index, hypertension, diabetes mellitus, hypedipidemia, Killip class, serum cardiac troponin I and left ventricular ejection fraction between the two groups （ P 〉 0. 05 ） . But the age and serum ereatinine in normal eGFR group were lower than those in low eGFR group （ P 〈 0. 05 ） . There was no statistically significant difference in infarct - related artery （IRA） , coronary lesion and left main trunk disease between the two groups （ P 〉 0. 05 ） . There was no statistically significant difference in incidence of target vessel revasc

关 键 词：心肌梗死 肾小球滤过率 预后 血管成形术 气囊 冠状动脉 

分 类 号：R542.22[医药卫生—心血管疾病]