急性心肌梗死后急性肾损伤影响因素及对住院期间不良心血管事件的影响  

Influential factors of acute kidney injury after acute myocardial infarction and its effect on adverse cardiovascular events during hospitalization

作　　者：闫明聪 尹春琳[2] 张燕莉[3] Yan Mingcong;Yin Chunlin;Zhang Yanli(Department of Cardiology,Daxing District People's Hospital of Beijing City,Beijing 102600,China;Department of Cardiology,Xuanwu Hospital,Capital Medical University,National Clinical Research Center for Geriatric Diseases,Beijing 100053,China;Neurobiology Room,Xuanwu Hospital,Capital Medical University,National Clinical Research Center for Geriatric Diseases,Beijing 100053,China)

机构地区：[1]北京市大兴区人民医院心内科,北京102600 [2]首都医科大学宣武医院心内科,国家老年疾病临床医学研究中心,北京100053 [3]首都医科大学宣武医院神经生物室,国家老年疾病临床医学研究中心,北京100053

出　　处：《中国医师进修杂志》2022年第1期18-24,共7页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨急性心肌梗死(AMI)患者急性肾损伤(AKI)发生率和危险因素及对住院期间不良心血管事件的影响。方法回顾性分析2014年12月至2017年12月首都医科大学宣武医院1286例首发AMI患者的临床资料。收集患者的基本信息、实验室检查结果、药物使用情况等,并记录AKI和住院期间不良心血管事件发生情况。结果1286例AMI患者中,113例发生AKI,发生率为8.79%。AKI患者与非AKI患者性别构成、年龄、Killip分级>1级、高血压、糖尿病、吸烟史、左心室射血分数(LVEF)<56%、基线估算肾小球滤过率(eGFR)<71.5 ml/(min·1.73 m^(2))、全球急性冠状动脉事件注册评分(GRACE评分)≥176分、血红蛋白<128 g/L、白细胞介素-6(IL-6)≥35.74 ng/L、B型利钠肽(BNP)≥981 ng/L、心肌梗死溶栓评分(TIMI评分)≥5分、高敏C反应蛋白(hs-CRP)≥8.44 mg/L、入院血清肌酐≥90μmol/L、心率≥75次/min和造影剂用量/eGFR≥1.92比较差异有统计学意义(P<0.01或<0.05)。多因素Logistic回归分析结果显示,糖尿病、LVEF<56%、基线eGFR<71.5 ml/(min·1.73 m^(2))和hs-CRP≥8.44 mg/L是影响AMI患者发生AKI的独立危险因素(OR=2.99、0.38、0.30和2.48,95%CI 1.31~6.84、0.16~0.88、0.12~0.78和1.07~5.75,P=0.010、0.024、0.013和0.035)。AKI患者住院病死率、住院期间不良心血管事件发生率和住院时间明显高于非AKI患者[11.50%(13/113)比2.39%(28/1173)、22.12%(25/113)比8.40%(99/1173)和(12±8)d比(10±6)d],差异有统计学意义(P<0.01)。多因素Logistic回归分析结果显示,AKI是AMI患者发生住院期间死亡和不良心血管事件的独立危险因素(OR=5.32和3.08,95%CI 2.67~10.59和1.89~5.03,P<0.01)。结论AMI患者中AKI的发生率较高,伴有糖尿病、LVEF<56%、eGFR<71.5 ml/(min·1.73 m^(2))、hs-CRP≥8.44 mg/L是AMI患者发生AKI的独立危险因素。AMI患者发生AKI后会增加住院期间不良心血管事件发生率和住院病死率,并延长住院时间。Objective To observe the incidence and risk factors of acute kidney injury(AKI)in patients with acute myocardial infarction(AMI),and explore the effect of AKI on the adverse cardiovascular events during hospitalization.Methods The clinical data of 1286 first-episode patients with AMI from December 2014 to December 2017 in Xuanwu Hospital,Capital Medical University were retrospectively analyzed.The basic information,laboratory test results and used drug were collected,the incidences of AKI and adverse cardiovascular events during hospitalization were recorded.Results Among 1286 patients with AMI,113 cases had AKI,the incidence of AKI was 8.79%.There were statistical differences in gender composition,age,Killip classification>1 grade,hypertension,diabetes,smoking history,left ventricular ejection fraction(LVEF)<56%,baseline estimated glomerular filtration rate(eGFR)<71.5 ml/(min·1.73 m^(2)),global registry of acute coronary events score(GRACE score)≥176 scores,hemoglobin<128 g/L,interleukin-6(IL-6)≥35.74 ng/L,brain natriuretic peptide(BNP)≥981 ng/L,thrombolysis in myocardial infarction score(TIMI score)≥5 scores,high-sensitivity C-reactive protein(hs-CRP)≥8.44 mg/L,serum creatinine at admission≥90μmol/L,heart rate≥75 times/min and contrast agent dosage/eGFR≥1.92 between patients with AKI and patients without AKI(P<0.01 or<0.05).Multivariate Logistic regression analysis result showed that diabetes,LVEF<56%,baseline eGFR<71.5 ml/(min·1.73 m^(2))and hs-CRP≥8.44 mg/L were the independent risk factors of AKI in patients with AMI(OR=2.99,0.38,0.30 and 2.48;95%CI 1.31 to 6.84,0.16 to 0.88,0.12 to 0.78 and 1.07 to 5.75;P=0.010,0.024,0.013 and 0.035).The hospital mortality,incidence of adverse cardiovascular events during hospitalization and length of hospital stay in patients with AKI were significantly higher than those in patients without AKI:11.50%(13/113)vs.2.39%(28/1173),22.12%(25/113)vs.8.40%(99/1173)and(12±8)d vs.(10±6)d,and there were statistical differences(P<0.01).Multivariate Logistic regr

关 键 词：心肌梗塞 急性肾功能不全 危险因素 预后 

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