血红蛋白水平对急性心肌梗死患者发生急性肾损伤风险的影响  

Effects of hemoglobin level on the risk of acute kidney injury in patients with acute myocardial infarction

作　　者：孙铃[1] 迟博予 毛丽鹏 邹艾霖 王庆捷[1] 蒋建光[1] 纪元[1] 周学军[1] Sun Ling;Chi Boyu;Mao Lipeng;Zou Ailin;Wang Qingjie;Jiang Jianguang;Ji Yuan;Zhou Xuejun(Department of Cardiology,the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University,Changzhou 213000,Jiangsu,China;Dalian Medical University,Dalian 116000,Liaoning,China)

机构地区：[1]南京医科大学附属常州市第二人民医院心血管内科,江苏常州213000 [2]大连医科大学,辽宁大连116000

出　　处：《中华危重病急救医学》2022年第12期1243-1247,共5页Chinese Critical Care Medicine

基　　金：江苏省自然科学基金面上项目(BK20221229);江苏省常州市青苗人才计划(CZQM2020060);江苏省常州市医药卫生科技项目(ZD202020);江苏省常州市科技计划项目(CJ20210059)。

摘　　要：目的观察急性心肌梗死(AMI)患者术前血红蛋白(Hb)水平对经皮冠状动脉介入治疗(PCI)后发生急性肾损伤(AKI)风险的影响。方法采用回顾性研究方法。选择2015年5月至2020年5月在南京医科大学附属常州市第二人民医院心血管内科住院的接受PCI的AMI患者作为研究对象。根据PCI前后血肌酐(SCr)水平将患者分为AKI组和非AKI组。比较是否发生AKI两组患者Hb水平的差异;采用单因素和多因素Logistic回归分析Hb水平对AMI患者行PCI后发生AKI风险的影响;采用Kaplan-Meier生存曲线评价Hb水平对AMI患者发生院内全因死亡的影响。结果共入选接受PCI的AMI患者922例, 其中165例(17.9%)发生了AKI。与非AKI组比较, AKI组患者女性比例较高〔35.8%(59/165)比26.9%(204/757)〕, 年龄更大(岁:69.78±14.56比66.61±13.44), 吸烟比例更低〔42.4%(70/165)比51.7%(391/757)〕, 合并高血压比例更高〔73.3%(121/165)比63.5%(481/757)〕, 心功能更差〔Killip分级≥3级患者比例更高, 33.9%(56/165)比13.9%(105/757)〕, Hb水平更低(g/L:127.61±22.18比132.79±19.45),使用血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)类药物比例更低〔60.0%(99/165)比74.5%(564/757)〕, 使用利尿剂类药物比例更高〔24.8%(41/165)比17.7%(134/757)〕, 差异均有统计学意义(均P<0.05)。而AKI组患者手术时间>60 min〔4.2%(7/165)比1.5%(11/757)〕、术中造影剂用量>100 mL〔16.4%(27/165)比3.6%(27/757)〕、术中出现低血压〔16.4% (27/165)比8.2%(62/757)〕和植入≥2枚支架〔8.5%(14/165)比3.6%(27/757)〕的患者比例均较非AKI组更高(均P<0.05)。单因素回归分析显示, 术前Hb水平每升高1 g/L, 术后AKI风险下降1.2% 〔优势比(OR)=0.988, 95%可信区间(95%CI)为0.980~0.996, P=0.003〕;而术前Hb水平每升高1个标准差, 术后AKI风险则下降22.1%(OR=0.779, 95%CI为0.661~0.918, P=0.003)。将患者再按Hb水平分为低、中、高3个浓度组(Hb水平分别为<110 g/L、110~15Objective To investigate the effect of preoperative hemoglobin(Hb)level on the risk of developing acute kidney injury(AKI)after percutaneous coronary intervention(PCI)in patients with acute myocardial infarction(AMI).Methods A retrospective study was conducted.The hospitalized patients diagnosed with AMI who underwent PCI from May 2015 to May 2020 in the department of cardiology in the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University were enrolled.According to the serum creatinine(SCr)level before and after interventional therapy,the patients were divided into an AKI group and a non-AKI group.The difference in patients'Hb levels between the AKI and non-AKI groups was compared.Univariate and multivariate Logistic regression analyses were used to analyze the effects of Hb levels on the risk of AKI after interventional therapy in patients with AMI.Kaplan-Meier survival curve was used to evaluate the effects of Hb levels on patients with AMI in all-cause death in the hospital.Results A total of 922 AMI patients were enrolled in this study,of which 165 patients(17.9%)developed AKI.Compared with the non-AKI group,female patients in the AKI group had a higher proportion[35.8%(59/165)vs.26.9%(204/757)],older(age:69.78±14.56 vs.66.61±13.44),with a lower rate of smoking[42.4%(70/165)vs.51.7%(391/757)]and a higher prevalence of hypertension[73.3%(121/165)vs.63.5%(481/757)],however,the patients in AKI group also had a worse cardiac function[the proportion of Killip grade 3 or above was higher:33.9%(56/165)vs.13.9%(105/757)],lower Hb level(g/L:127.61±22.18 vs.132.79±19.45),and there were less patients using angiotensin converting enzyme inhibitor/angiotensinⅡreceptor blocker[ACEI/ARB,60.0%(99/165)vs.74.5%(564/757)]and more patients using diuretics[24.8%(41/165)vs.17.7%(134/757)]in AKI group,the differences were statistically significant(all P<0.05).Compared with non-AKI group,patients in AKI group had a longer operation time[operation time>60 minutes:4.2%(7/165)vs.1.5%(11/757)]and received more

关 键 词：急性心肌梗死 血红蛋白 急性肾损伤 介入治疗 

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