肾功能下降与急性心肌梗死患者急诊经皮冠状动脉介入治疗后预后的关系研究  

Relationship between Decreased Renal Function and Prognosis in Postoperative Acute Myocardial Infarction Patients Treated by Emergency PCI

作　　者：郑锦滨[1] 黄贤生[1] 

机构地区：[1]汕头大学医学院第一附属医院心血管内科三病区,广东省汕头市515041

出　　处：《实用心脑肺血管病杂志》2017年第8期28-32,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：广东省科技计划项目(2016B031700058)

摘　　要：目的探讨肾功能下降与急性心肌梗死(AMI)患者急诊经皮冠状动脉介入治疗(PCI)后预后的关系。方法选取2014年1月—2016年2月在汕头大学医学院第一附属医院行急诊PCI的AMI患者466例,根据估算肾小球滤过率(e GFR)分为肾功能正常组207例[eGFR≥90 ml·min^(-1)·(1.73 m^2)^(-1)]、肾功能轻度降低组169例[60 ml·min^(-1)·(1.73 m^2)^(-1)≤e GFR<90 ml·min^(-1)·(1.73 m^2)^(-1)]及肾功能中度降低组90例[30 ml·min^(-1)·(1.73 m^2)^(-1)≤e GFR<60 ml·min^(-1)·(1.73 m^2)^(-1)];随访1年,根据主要不良心血管事件(MACE)发生情况分为MACE组91例和非MACE组375例。比较肾功能正常组、肾功能轻度降低组、肾功能中度降低组患者MACE发生率及冠状动脉病变支数、Killip分级情况,AMI患者急诊PCI后MACE的影响因素分析采用多因素Logistic回归分析。结果(1)随访1年,共91例患者出现MACE。肾功能正常组患者MACE发生率为9.2%,肾功能轻度下降组为17.2%,肾功能中度下降组为47.8%;3组患者MACE发生率比较,差异有统计学意义(P<0.05)。(2)肾功能轻度下降组与肾功能中度下降组冠状动脉病变支数多于肾功能正常组,Killip分级劣于肾功能正常组(P<0.05)。(3)MACE组与非MACE组患者性别、体质指数(BMI)比较,差异无统计学意义(P>0.05);两组患者年龄、血肌酐(Scr)、e GFR、左心室射血分数(LVEF)、冠状动脉病变支数、Killip分级、有无高血压、有无糖尿病、有无高脂血症、有无吸烟史、有无饮酒史比较,差异有统计学意义(P<0.05)。(4)多因素Logistic回归分析结果显示,高血压[OR=2.370,95%CI(1.766,3.180)]、糖尿病[OR=1.664,95%CI(1.223,2.263)]、LVEF<50%[OR=2.389,95%CI(1.900,3.005)]及eGFR<90 ml·min^(-1)·(1.73 m^2)^(-1)[OR=2.462,95%CI(1.886,3.214)]是AMI患者急诊PCI后MACE的独立危险因素(P<0.05)。结论肾功能下降可导致AMI患者急诊PCI后预后不良风险性升高,高血压、糖尿病、LVEF<50%及e GFR<90 ml·min^(-1)·(1.73 m^2)^(-Objective To investigate the relationship between decreased renal function and prognosis in postoperative acute myocardial infarction patients treated by emergency PCI. Methods From January 2014 to February 2016,a total of 466 patients undergoing emergency PCI were selected in the First Affiliated Hospital of Medical College,Shantou University,and they were divided into A group [with normal renal function and eGFR equal or over 90 ml·min^-1·（ 1. 73 m^2）^-1,n = 207],B group [with mild decreased renal function and eGFR less than 90 ml·min^-1·（ 1. 73 m^2）^-1but equal or over 60 ml·min^-1·（ 1. 73 m^2）^-1,n = 169]and C group [with moderate decreased renal function and eGFR less than 60 ml·min^-1·（ 1. 73m^2）^-1but equal or over 30 ml·min^-1·（ 1. 73 m^2）^-1,n = 90]according to eGFR,into D group（ n = 91） and E group（ n= 375） according to the incidence of MACE during the 1-year follow-up. Incidence of MACE,number of stenosed coronary artery and Killip grading were compared among A group,B group and C group; influencing factors of MACE in postoperative acute myocardial infarction patients treated by emergency PCI were analyzed by multivariate Logistic regression analysis. Results（ 1） A total of 91 cases occurred MACE during the 1-year follow-up; incidence of MACE of A group was 9. 2%,of B group was 17. 2%,of C group was 47. 8%,there were statistically significant differences of incidence of MACE among A group,B group and C group（ P〈0. 05）.（ 2） Number of stenosed coronary artery of B group and C group was statistically significantly more than that of A group,respectively,Killip grading of B group and C group was statistically significantly worse than that of A group,respectively（ P〈0. 05）.（ 3） No statistically significant differences gender or BMI was found between D group and E group（ P〉0. 05）, while there were statistically significant differences of age, Scr, eGFR, LVEF, number of stenosed coronary artery, Killip grading, hypertension, diabetes and hyper

关 键 词：心肌梗死 肾小球滤过率 血管成形术 气囊 冠状动脉 预后 危险因素 

分 类 号：R542.22[医药卫生—心血管疾病]