心肌肌钙蛋白Ⅰ水平与急诊经皮冠状动脉介入术后对比剂肾病风险的关系

Association between the cardiac troponin Ⅰ level and the risk of contrast-induced nephropathy in patients with acute myocardial infarction undergoing percutaneous coronary intervention

目的 观察急性心肌梗死（AMI）患者经皮冠状动脉介入（PCI）术前心肌肌钙蛋白Ⅰ（cTnI）水平与术后对比剂肾病（CIN）风险的关系. 方法 回顾性收集2011年1月至2013年6月在我院心脏中心行急诊PCI治疗的cTnI升高（＞0.4 μg/L）的235例老年AMI患者的临床资料,按照术前cTnI水平分为cTnI＜4.0 μg/L组133例、cTnI≥4.0 μgL）组102例.记录患者基线情况、术前及术后1、3、7d血尿素（BUN）、肌酐（Scr）、β2-微球蛋白（β2-MG）,并计算肾小球滤过率（eGFR）,术后记录对比剂用量、冠状动脉病变特点,观察术后1年内临床事件发生情况,采用多因素Logistic回归分析CIN的影响因素. 结果 cTnI≥4.0 μg/L患者CIN发生率为22.55％（23/102）高于cTnI＜4.0 μg/L组10.53％（14/133）,差异有统计学意义（x2=21.56,P＜0.01）;两组患者在急诊PCI术后第1天均出现eGFR下降和β2-MG升高,且cTnI≥4.0μg/L组较cTnI＜4.0μg/L组患者的eGFR下降及β2-MG升高幅度更明显（P＜0.05）,术后第7天时均恢复到术前水平;cTnI≥4.0 μg/L组3支血管病变例数多于cTnI＜4.0 μg/L组（x2=16.60,P＜0.01）,置入支架数量少于cTnI＜4.0 μg/L组（x2 =6.41,P＜0.05）;cTnI≥4.0 μg/L组发生再发心绞痛、急性心力衰竭及死亡高于cTnI＜4.0μg/L组（P＜0.05）;多因素Logistic回归分析结果显示,术前高cTnI（OR=2.160）、糖尿病（OR=3.056）、肾功能不全（OR=1.632）、对比剂用量（OR=3.665）、高龄（OR=3.521）是术后发生CIN的危险因素. 结论 术前cTnI水平与急诊PCI术后CIN发生率相关,术前高cTnI水平是CIN的临床危险因素.

Objective To analyze the association between the cardiac troponin Ⅰ （cTnI） level and the risk of contrast-induced nephropathy （CIN） in patients with acute myocardial infarction （AMI） undergoing percutaneous coronary intervention （PCI）.Methods Clinical data of 235 elderly patients with AMI who underwent PCI from January 2011 to June 2013 in our hospital were analyzed retrospectively.Patients were divided into two groups based on preprocedural cTnI levels： the moderate cTnI level group （0.4 μg/L）〈cTnI〈4 μg/L, n=133） and the high cTnI level group （cTnI ≥4 μgL, n=102）.The following data were recorded： the baseline measurements, blood urea nitrogen （BUN）, serum creatinine （Scr）, （2-microglobulin （β2-MG） levels before PCI and 1 d, 3 d,and 7 d after PCI, estimated glomerular filtration rate （eGFR）, the contrast volume and coronary pathological features after PCI, and occurrence of clinical events within 1 year.Risk factors for CIN were determined by multivariate logistic regression analysis.Results The incidence of CIN was significantly higher in the high cTnI level group than in the moderate cTnI level group [22.55% （23/ 102） vs.10.53% （14/133）, x2 =21.56, P〈0.01].eGFR declined and the β2-MG level increased more significantly in the high cTnI level group than in the moderate cTnI level group （P〈0.05）, and went back to baseline levels 7 days after PCI.Patients with three-vessel lesions were more likely to be in the high cTnI level group than in the moderate cTnI level group （x2 =16.60, P〈0.01）, and the number of stents was lower in the high cTnI level group than in the moderate cTnI level group （x2 =6.41, P〈0.05）.The rates of angina pectoris, acute heart failure and mortality were higher in the high cTnI level group than in the moderate cTnI level group （P〈 0.05）.Multivariate logistic regressive analysis showed that high levels of preprocedural cTnI （OR=2.160）, diabetes （OR=3.056）, renal insufficiency （OR=1.632）, contrast volume （OR=3.665）, and old age （OR=3.521）were risk factors for the incidence of CIN.Conclusions The preprocedural cTnI level is associated with the incidence of CIN in patients with AMI undergoing PCI, and high preprocedural cTnI levels are a clinical risk factor for CIN.