急性心肌梗死治疗中应用前蛋白转化酶枯草杆菌蛋白酶/kexin9型抑制剂对对比剂所致急性肾损伤的影响  

Role of proprotein convertase subtilisin/kexin type 9 inhibitors on contrast-induced acute kidney injury in patients with acute myocardial infarction

作　　者：马宇[1] 查磊 张琦[1] 张敬霞[1] 韩姗[1] 任珉[2] 马静[2] 李春洁[3] 侯凯 赵丰[5] 丛洪良[1] 李曦铭[1] MA Yu;ZHA Lei;ZHANG Qi;ZHANG Jing-xia;HAN Shan;REN Min;MA Jing;LI Chun-jie;HOU Kai;ZHAO Feng;CONG Hong-liang;LI Xi-ming(Department of Cardiovascular Medicine,Tianjin Chest Hospital,Tianjin 300222,China;Tianjin Institute of Cardiovascular Diseases;Emergency Department of Tianjin Chest Hospital;Tianjin Nankai University School of Medicine;Department of Cardiovascular Surgery,Tianjin Chest Hospital)

机构地区：[1]天津市胸科医院心血管内科,天津300222 [2]天津心血管病研究所 [3]天津市胸科医院急诊科 [4]天津南开大学医学院 [5]天津市胸科医院心血管外科

出　　处：《中华高血压杂志》2022年第3期260-266,共7页Chinese Journal of Hypertension

基　　金：天津市胸科医院科研项目(2018XKZ19);天津市卫生健康科技项目(青年项目)(TJWJ2021QN057);天津市医学重点学(专)科建设项目。

摘　　要：目的探讨前蛋白转化酶枯草杆菌蛋白酶/kexin9型(PCSK9)抑制剂在急性心肌梗死患者行经皮冠状动脉介入(PCI)治疗过程中对对比剂所致急性肾损伤(CI-AKI)的作用。方法回顾性分析行PCI手术的急性心肌梗死患者235例,并于术后24~72 h内复查血肌酐。按照有无应用PCSK9抑制剂依洛尤单抗进行分组,比较相关指标;按照有无发生CI-AKI进行分组,对数据进行单因素分析,筛选出导致CI-AKI发生的可疑影响因素,然后纳入可疑影响因素及业界公认的影响因素进行多因素logistic回归分析。结果按照有无应用依洛尤单抗分组,与对照组比较,依洛尤单抗组CI-AKI发病率降低(7.8%比20.0%,χ^(2)=7.21,P<0.01)。多因素logistic回归分析发现应用依洛尤单抗是CI-AKI发生的保护因素(OR=0.28,95%CI 0.11~0.71,P<0.01)。结论急性心肌梗死患者行PCI治疗中应用PCSK9抑制剂可降低CI-AKI的发生率。Objective To investigate the effect of proprotein convertase subtilisin/kexin type 9(PCSK9)inhibitors on contrast-induced acute kidney injury(CI-AKI)in patients with acute myocardial infarction who underwent percutaneous coronary intervention(PCI).Methods A retrospective analysis was made in 235 patients with acute myocardial infarction who underwent successful PCI with blood creatinine measured within 24-72 hours after operation.According to the presence or absence of PCSK9 inhibitors(evolocumab),the related clinical indicators were compared.And then the data were grouped according to the occurrence of CI-AKI and univariate analysis was conducted to screen the suspected influencing factors leading to the occurrence of CI-AKI.Finally multivariate logistic regression analysis was conducted on the possible influencing factors and the known influencing factors.Results The incidence of CI-AKI in evolocumab group(7.8%)was lower than that in control group(20.0%)and the difference was statistically significant(χ^(2)=7.21,P<0.01).Multivariate logistic regression analysis indicated that evolocumab was a protective factor for the CI-AKI(OR=0.28,95%CI 0.11-0.71,P<0.01).Conclusion PCSK9 inhibitor can reduce the incidence of CI-AKI in patients undergoing PCI for acute myocardial infarction.

关 键 词：对比剂所致肾损伤 急性心肌梗死 前蛋白转化酶枯草杆菌蛋白酶/kexin9型抑制剂 

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