AMI早期血糖波动对造影剂相关急性肾损伤的影响  

Influence of blood glucose fluctuations in early AMI on contrast-associated acute kidney injury

作　　者：王林琳 戴李华 刘新兵[2] WANG Lin-lin;DAI Li-hua;LIU Xin-bing(Department of Critical Care Medicine etc.,Shidong Hospital of Yangpu District,Shanghai City,Shanghai,200438,China)

机构地区：[1]上海市杨浦区市东医院重症医学科,上海200438 [2]上海市杨浦区市东医院心血管内科,上海200438

出　　处：《心血管康复医学杂志》2021年第5期521-525,共5页Chinese Journal of Cardiovascular Rehabilitation Medicine

基　　金：上海市卫生健康委面上项目(201840373);上海市杨浦区2019-2022年度重点学科A类项目(YP19ZA07)。

摘　　要：目的:研究AMI早期平均血糖波动幅度(MAGE)对造影剂相关急性肾损伤(CA-AKI)的影响。方法:依据急诊PCI术后72hMAGE,我院184例AMI患者被分为血糖平稳组(MAGE<3.9mmol/L,113例)与血糖波动组(MAGE≥3.9mmol/L,71例)。分析MAGE与术后72h肌酐(SCr)水平变化幅度的相关性,以及72h SCr变化幅度和CA-AKI的影响因素。结果:与血糖平稳组比较,血糖波动组糖尿病史比例(66.4%比87.3%)、Mehran评分[6(3,7)分比6(6,9)分]、术后24h血清胱抑素C(CysC)水平[0.76(0.71,0.86)mg/L比1.12(0.91,0.28)mg/L]、术后48h尿n-乙酰-β-d-氨基葡萄糖苷酶(NAG)水平[7.80(5.10,9.86)U/L比10.20(7.10,24.00)U/L]、术后72hSCr水平变化幅度[6.5(-0.10,18.60)U/L比15.30(4.40,30.10)U/L]和CA-AKI发生率(5.3%比14.1%)均显著升高,P<0.05或<0.01。Pearson相关性分析显示,MAGE与术后72hSCr水平变化幅度呈显著正相关(r=0.333,P=0.001)。多因素线性回归分析提示糖尿病、MAGE、术前收缩压是术后72h肌酐变化幅度的独立危险因素(β=0.114~8.067,P<0.05或<0.01),而术前适量SCr是其独立保护因素(β=-0.322,P=0.001)。多因素修正Poisson回归分析显示糖尿病、MAGE、术前SBP为CA-AKI发生的独立危险因素(RR=1.027~6.361,P<0.05或<0.01),适量造影剂和术前SCr是其独立保护因素(RR=0.979、0.949,P=0.020、0.010)。结论:AMI早期血糖波动是CA-AKI发生的独立危险因素。Objective:To study influence of blood glucose fluctuations(MAGE)on contrast-associated acute kidney injury(CA-AKI)in early AMI.Methods:According to mean amplitude of MAGE in 72h after emergency PCI,the 184 AMI patients of our hospital were divided into stable glucose group(MAGE<3.9mmol/L,n=113)and glucose fluctuation group(MAGE≥3.9mmol/L,n=71).Correlation between MAGE and creatine(SCr)level change in 72h after PCI was analyzed.Influencing factors for SCr change amplitude in 72h and CA-AKI were analyzed.Results:Compared with stable glucose group,there were significant rise in percentage of DM history(66.4%vs.87.3%),Mehran score[6(3,7)scores vs.6(6,9)scores],serum cystatin C(CysC)level in 24h after PCI[0.76(0.71,0.86)mg/L vs.1.12(0.91,0.28)mg/L],urinen-acetyl-β-d-glucosaminidase(NAG)level in 48h after PCI[7.80(5.10,9.86)U/L vs.10.20(7.10,24.00)U/L],SCr level change amplitude in 72h after PCI[6.5(-0.10,18.60)U/L vs.15.30(4.40,30.10)U/L]and incidence rate of CA-AKI(5.3%vs.14.1%)in glucose fluctuation group,P<0.05 or<0.01.Pearson correlation analysis indicated that MAGE was significant positively correlated with SCr level change amplitude in 72h after PCI(r=0.333,P=0.001).Multivariate linear regression analysis indicated that DM,MAGE and preoperative SBP were independent risk factors for SCr change amplitude in 72h after PCI(β=0.114~8.067,P<0.05 or<0.01),while preoperative SCr was its independent protective factor(β=-0.322,P=0.001).Multivariate modified Poisson regression analysis indicated that DM,MAGE,preoperative SBP were independent risk factors for CA-AKI(RR=1.027~6.361,P<0.05 or<0.01),while contrast dose and preoperative SCr were its independent protective factors(RR=0.979,0.949,P=0.020,0.010).Conclusion:Blood glucose fluctuation is an independent risk factor for CA-AKI.

关 键 词：心肌梗死 血糖 造影剂 急性肾损伤 

分 类 号：R542.2209[医药卫生—心血管疾病]