脂代谢异常对急性心肌梗死伴急性肾损伤患者的影响  

Effect of abnormal lipid metabolism on acute kidney injury in patients with acute myocardial infarction

作　　者：沈洋[1] 张茜 王攀 SHEN Yang;ZHANG Qian;WANG Pan(Department of NephrologyBeijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Heart Center&Beijing Key Laboratory of Hypertension,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院肾内科,北京市100020 [2]首都医科大学附属北京朝阳医院心脏中心高血压病研究北京市重点实验室

出　　处：《中国心血管病研究》2023年第7期619-625,共7页Chinese Journal of Cardiovascular Research

摘　　要：目的研究急性心肌梗死(AMI)住院患者急性肾损伤(AKI)的发生率、住院死亡率和相关危险因素,并探讨脂代谢异常对AMI伴AKI患者的影响。方法我们收集2019年1月~2020年12月在北京朝阳医院心内科确诊的急性心肌梗死患者1742例。AKI诊断标准参考2012年改善全球肾脏病预后组织(KDIGO)制定的国际标准,分为AKI组和非AKI组,并将AKI组患者进一步分为AKI-1期、2期和3期。采用多因素logistic回归分析AKI的相关危险因素。结果263例(15.1%)在住院期间发生AKI。AKI组患者的住院时间[(13.20±8.27)d比(8.44±5.05)d,P<0.001]和病死率(8%比0.7%,P<0.001)均显著高于非AKI组。AKI组患者存在更多的高脂血症合并症,总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)和游离脂肪酸(FFA)水平更高。多因素logistic回归分析显示,慢性肾脏病(CKD)、高血压、高脂血症病史、ST段抬高型心肌梗死(STEMI)、白细胞计数、空腹血糖(FPG)、FFA、基线血肌酐水平升高、入院心率加快是AKI的独立危险因素,其中CKD病史是AMI患者AKI的最强独立危险因素(OR=44.534,95%CI 12.401~159.930,P<0.001);而舒张压(DBP)升高(OR=0.910,95%CI 0.851~0.974,P=0.006)可能是AKI患病率的保护因素。FFA水平在AKI组患者中明显升高(P<0.001),且是AMI患者发生AKI的独立危险因素(OR=1.048)。结论AKI是AMI是一种常见且严重的并发症,与AMI患者的住院死亡率增加密切相关。AMI伴AKI患者普遍存在脂质代谢异常,其通过多种途径参与AKI发生发展。Objective To investigate the impact of abnormal lipid metabolism on acute kidney injury(AKI)in patients with acute myocardial infarction(AMI).Method 1742 patients with acute myocardial infarction diagnosed in the cardiology department of Beijing Chaoyang Hospital from January 2019 to December 2020 were collected.The diagnostic criteria for AKI was referred to the international standards developed by the 2012 Global Organization for Improving Kidney Disease Prognosis(KDIGO).The patients were divided into the AKI group and non-AKI group,and the AKI group patients were further divided into the AKI-1,2 and 3 stages.Multiple logistic regression analysis was used to identify the risk factors associated with AKI.Result 263 people(15.1%)experienced AKI during hospitalization.The hospitalization time[(13.20±8.27)days vs.(8.44±5.05)days,P<0.001]and mortality rate(8%vs.0.7%,P<0.001)of patients in the AKI group were significantly higher than those in the non-AKI group.The AKI group had more hyperlipidemic comorbidities,with higher levels of total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C)and free fatty acid(FFA).Multivariate logistic regression analysis showed that chronic kidney disease(CKD),hypertension,hyperlipidemia,ST segment elevation myocardial infarction(STEMI),white blood cell count,fasting blood glucose(FPG),FFA,baseline creatinine levels and admission heart rate were all the independent risk factors for AKI.CKD history was the strongest independent risk factor for AKI in the AMI patients(OR=44.534,95%CI 12.401-159.930,P<0.001).The increase in diastolic blood pressure(DBP)(OR=0.910,95%CI 0.851-0.974,P=0.006)would be a protective factor for the incidence of AKI.FFA level was significantly elevated in the AKI group(P<0.001)and was an independent risk factor for AKI in the AMI patients(OR=1.048).Conclusion AKI is a common and serious complication of AMI,closely related to the increased hospitalization mortality rate of AMI patients.Patients with AMI and AKI generally have abnormal lipid metabolism,wh

关 键 词：急性心肌梗死 急性肾损伤 脂质代谢 危险因素 

分 类 号：R542.22[医药卫生—心血管疾病]