非ST段抬高心肌梗死预后因素分析及合并肾功能不全的临床特征

Analysis of prognostic patients with non-ST-segment elevation acute myocardial infarction and clinical characteristics of those with renal dysfunction

目的:评价NSTEMI合并肾功能不全患者的临床特点、NSTEMI患者院内死亡及6个月不良事件的相关因素。方法:选择自2006年1月至2007年9月初次因NSTEMI住院的患者116例,以适合我国人群的改良简化MDRD方程估算肾小球滤过率(eGFR),eGFR<60mL/(min.1.73m2)和/或有>3个月的慢性肾损害证据者定义为肾功能不全患者组(n=34),记录临床资料并评价院内死亡及6个月不良事件的相关因素。结果:肾功能不全的患者占29.3%(34/116),与肾功能正常的患者相比,肾功能不全的患者组中年龄大、有高血压、糖尿病及心绞痛史者更为常见;入院时心功能killip分级为Ⅲ～Ⅳ级者较多,入院时血浆纤维蛋白原高,左室射血分数低;肾功能不全患者组在住院期间接受冠状动脉造影的例数相对较少,冠状动脉钙化的比例高,接受经皮冠状动脉成形术治疗的病例少,与肾功能正常的患者组比较差异均有统计学意义。将单因素分析中差异有统计学意义的指标进行多因素logistic分析显示:入院时心功能高killip分级(OR=13.12,P=0.000)是NSTEMI院内死亡的独立相关因素;而入院时高killip分级(OR=6.265,P=0.002)、合并肾功能不全(OR=3.545,P=0.007)是NSTEMI患者6个月不良事件发生的独立预测因素。结论:肾功能不全的患者组中,高龄、合并高血压、糖尿病及有心绞痛史者更为常见;入院时心功能killip分级为Ⅲ～Ⅳ级者较多;冠状动脉钙化的比例高。入院时心功能高killip分级是NSTEMI院内死亡的独立相关因素,而入院时高killip分级、合并肾功能不全是NSTEMI患者6个月不良事件发生的独立预测因素。

Objective：To evaluate the clinical features of non-ST-segment-elevation myocardial infarction （NSTEMI） patients with renal dysfunction and investigate correlation factor for in-hospital death and 6 months adverse events of NSTEMI patients. Methods： One hundred and sixteen patients presenting with NSTEMI were enrolled between January 2006 and September 2007. Estimation of glomerular filtrate rate （eGFR） was conducted by the modified abbreviated MDRD equations based on the Chinese CKD patients. Renal dysfunction was defined as eGFR 〈 60 mL/（ min·1.73 m^2） and/or as having the other evidence of chronic kidney damage over 3 months or more. All the clinical data were collected. Correlation factors of in-hospital death and 6-month adverse events were evaluated. Results： 29. 3 percentage of patients presented with renal dysfunction （34/116）, patients with renal dysfunction were older, more likely to have history of hypertension, diabetes mellitus and angina compared with those with normal renal function,and more likely to be with heart function killip grades Ⅲ-Ⅳ, higher level of the plasma fibrinogen on admission, lower left ventricular ejection. Patients with renal dysfunction experienced less angiography, more coronary artery calcification, and less percutaneous coronary interventional treatment. Muhifactorial logistic regression analysis showed that killip grades Ⅲ-Ⅳ on admission （OR = 13.12, P = 0. 000） were independently correlated with the in hospital death, killip grades Ⅲ-Ⅳ on admission （ OR = 6. 265, P = 0. 002） and renal dysfunction （ OR = 3. 545, P = 0. 007） might be independent risk faetors of 6-month adverse events in patients with NSTEMI. Conclusion： Patients with renal dysfunction were older, more likely to have history of hypertension, diabetes mellitus and angina, and more likely to be with heart function killip grades Ⅲ-Ⅳ, more coronary artery calcification; killip grades Ⅲ-Ⅳ on ad- mission were independently correlated with the in-hospital death; killip grades Ⅲ-Ⅳ on admission and renal dysfunction might be independent risk factors of 6-month adverse events in patients with NSTEMI.