尿酸及二氧化碳结合力与急性心肌梗死患者急诊PCI术后对比剂性急性肾损害的相关性研究

Study on the relationship between uric acid,CO_2-CP and contrast induced acute kidney injury in patients with acute myocardial infarction undergoing percutaneous coronary intervention

目的探讨尿酸、二氧化碳结合力与急性心肌梗死患者急诊经皮冠状动脉介入治疗（PCI）后对比剂性急性肾损害（CI-AKI）的相关性。方法连续入选2012年1月至2014年6月入院的急性心肌梗死（包括急性ST段抬高型心肌梗死和急性非ST段抬高型心肌梗死）并行急诊PCI的208例患者的临床资料。将患者分为4组：Ⅰ组术前尿酸（UA）、二氧化碳结合力（CO2-CP）均正常;Ⅱ组高UA,CO2-CP正常;Ⅲ组UA正常,CO2-CP异常（〈22.0 mmol/L）;Ⅳ组高UA,CO2-CP〈22.0 mmol/L。前瞻性的观察4组患者的CI-AKI的发生率及院内临床事件。结果 208患者中12例发生CI-AKI（5.8%）,其中Ⅳ组7例（3.4%）,Ⅱ组3例（1.4%）,Ⅲ组2例（1.0%）,Ⅰ组为0例。多因素Logistic回归分析结果显示：年龄〉70岁（OR=1.045,95%CI：1.007~1.092,P=0.019）、术后低血压（OR=1.892,95%CI：1.229~2.751,P=0.001）、慢性心功能不全（OR=1.681,95%CI：1.227~2.298,P=0.001）、e GFR〈60 ml·min-1·1.73 m-2（OR=1.708,95%CI：1.168-2.495,P=0.005）、高尿酸（OR=1.896,95%CI：1.269~2.830,P=0.002）、二氧化碳结合力〈22.0 mmol/L（OR=1.695,95%CI：1.231-2.333,P=0.001）是CI-AKI的独立危险因素。结论高尿酸血症和二氧化碳结合力〈22.0 mmol/L是急性心肌梗死患者急诊PCI术后对比剂性急性肾损害的独立危险因素。

Objective To explore the relationship between uric acid,CO2- CP and contrast induced acute kidney injury（ CI- AKI） in patients with acute myocardial infarction（ AMI） undergoing percutaneous coronary intervention（ PCI）. Methods The AMI patients were randomly divided into four groups： patients with normal UA and CO2- CP value in the first group,patients only with abnormal UA in the second group,only abnormal CO2- CP in the third group,and patients with abnormal UA and CO2- CP value in the fourth group. The occurrence of CI- AKI and clinical events after PCI were observed and compared. Results There were 7 patients with CI- AKI in the fourth group（ 3. 4%）,3patients with CI- AKI in the second group（ 1. 4%）,2 patients with CI- AKI in the third group（ 1. 0%） and patients without CI- AKI in the first group. Multiple logistic regression analysis showed that independent risk factors for CI- AKI included age 〉70 years（ OR = 1. 045,95% CI：1. 007- 1. 092,P = 0. 019）,hypotension after PCI（ OR = 1. 892,95% CI： 1. 229- 2. 751,P = 0. 001）,chronic heart failure（ OR = 1. 681,95% CI： 1. 227- 2. 298,P = 0. 001）,e GFR 60 ml·min^- 1·1. 73 m^- 2（ OR = 1. 708,95% CI： 1. 168- 2. 495,P = 0. 005） and hyperuricemia（ OR = 1. 896,95% CI： 1. 269- 2. 830,P = 0. 002） and CO2- CP 22. 0 mmol / L（ OR = 1. 695,95% CI： 1. 231- 2. 333,P = 0. 001）.Conclusion Hyperuricemia and CO2- CP 22. 0 mmol / L are independent risk factors for CI- AKI after PCI in patients with AMI.