尿清蛋白/肌酐比值与急性非ST段抬高型心肌梗死患者发病早期心功能的相关性研究

Correlation between Urinary Albumin/Creatinine Ratio and Cardiac Function of Patients with Early Acute Non ST-Elevation Myocardial Infarction

目的探究尿清蛋白/肌酐比值(UACR)与急性非ST段抬高型心肌梗死(ANSTEMI)患者发病早期心功能的相关性。方法选取2013年9月—2014年12月首都医科大学附属北京同仁医院心内科收治的入院24 h内未行急诊介入治疗的ANSTEMI患者102例,根据UACR将患者分为正常组(UACR<30 mg/g,n=55)、微量清蛋白尿组(30 mg/g≤UACR<300 mg/g,n=26)和大量清蛋白尿组(UACR≥300 mg/g,n=21)。比较3组患者一般资料〔包括年龄、性别、体质指数(BMI)、发病时间、吸烟史、高血压病史、糖尿病病史、心绞痛病史、心肌梗死病史、低密度脂蛋白胆固醇(LDL-C)水平、血肌酐水平及心律失常发生情况等〕、Killip分级、B型脑钠肽(BNP)水平及超声心动图检查结果〔左心房内径(LAD)、左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVESd)及左心室射血分数(LVEF)〕。结果 3组患者年龄、性别、BMI、发病时间、吸烟史阳性率、高血压病史阳性率、糖尿病病史阳性率、心绞痛病史阳性率、心肌梗死病史阳性率、心律失常发生率及LDL-C水平比较,差异无统计学意义(P>0.05);大量清蛋白尿组患者血肌酐水平高于微量清蛋白尿组和正常组(P<0.05)。微量清蛋白尿组和大量清蛋白尿组患者Killip分级差于正常组(P<0.05);微量清蛋白尿组和大量清蛋白尿组患者BNP水平高于正常组,大量清蛋白尿组患者BNP水平高于微量清蛋白尿组(P<0.05)。大量清蛋白尿组患者LAD、LVEDd、LVESd大于正常组,LVEF小于微量清蛋白尿组和正常组,微量清蛋白尿组患者LVEF小于正常组(P<0.05)。结论 UACR升高的ANSTEMI患者发病早期心功能较差,UACR升高可能是ANSTEMI患者发病早期心功能不全的预测指标。

Objective To explore the correlation between urinary albumin/creatinine ratio（ UACR） and cardiac function of patients with early acute non ST- elevation myocardial infarction（ ANSTEMI）. Methods A total of 102 patients with ANSTEMI were selected in Beijing Tongren Hospital Affiliated to Capital Medical University from September 2013 to December 2014, all of them admitted to this hospital within 24 hours and did not treated by emergency PCI. According to UACR,the 102 patients were divided into A group（ with UACR 〈30 mg / g,n = 55）,B group（ with 30 mg / g≤UACR 300 mg / g,n = 26） and C group（ with UACR ≥300 mg / g,n = 21）. General information（ including age,gender,BMI,onset time,history of smoking,hypertension,diabetes,angina pectoris and myocardial infarction, LDL-C level, serum creatinine level and incidence of arhythmia）, Killip grading, BNP level and echocardiography examination results（ including LAD,LVEDd,LVESd and LVEF） were compared among the three groups. Results There was no statistically significant differences of age,gender,BMI,onset time,positive rate of history of smoking,hypertension,diabetes,angina pectoris or myocardial infarction,LDL-C level,or incidence of arrhythmia was found among the three groups（ P 〉0. 05）; serum creatinine level of C group was statistically significantly higher than that of A group and B group, respectively（ P 〈0. 05）. Killip grading of B group,C group was statistically significantly worse than that of A group（ P 〈0. 05）,respetively; BNP level of B group,C group was statistically significantly higher than that of A group,respetively and BNP level of C group was statistically significantly higher than that of B group（ P 〈0. 05）. LAD,LVEDd,LVESd of C group were statistically significantly higher than those of A group,while LVEF of C group was statistically significantly lower than that of A group,B group,respectively,and LVEF of B group was statistically significantly lower than that of A group（ P 〈0. 05）. Conclusion The cardiac function of early ANSTEMI patients with elevated UACR is relatively poor,and increasing of UACR may be a predictive index of cardiac insufficiency of early ANSTEMI patients.