急性心肌梗死病例致急性肾损伤危险因素分析

Risk factors of acute kidney injury in patients with acute myocardial infarction

目的调查急性心肌梗死（AMI）患者发生急性肾损伤（AKI）的危险因素。方法连续收集北京大学人民医院2013年10月至2014年5月符合AMI诊断标准病例，排除包括年龄〈18岁、住院时间〈2d、临床资料不完备、住院期间发生感染中毒性休克等并发症及终末期肾脏病或已行透析患者，从基线资料、心肌梗死病情、实验室检查、药物以及器械辅助等治疗等方面收集资料，并进行回顾性研究，分为有AKI及无AKI两组，利用SPSS19软件进行组间差异比较，以P〈0．05为差异具有统计学意义，从而获得AKI相关危险因素。结果共人选病例565例，发现AKI的发病率为16．1％，其中AKI组患者病死率为19．8％，非AKI组病死率为0．4％（P〈0．01）。单因素组间比较筛选出的危险因素包括：（1）基本病史年龄、高血压史、陈旧性心肌梗死、心力衰竭史、慢性肾脏病史、脑梗步匕史、周围血管病史；（2）心肌梗死病情心室纤颤、心率、Killip分级≥3级、左心室射血分数；（3）实验室资料血肌酐、eGFR、血红蛋白、尿素氮、肌钙蛋白I、B型脑钠肽、C反应蛋白、空腹血糖、白蛋白；（4）药物及器械辅助等治疗呋塞米最大日剂量、未使用ACEI／ARB类药物及他汀类药物、使用主动脉内球囊反搏、安置临时起搏器、实施冠状动脉介入治疗及冠状动脉旁路移植于术、进行机械通气治疗（P〈0．05）。结论本研究通过对AMI后AKI的危险因素进行分析，有助于识别高危患者，早期采取预防措施。

Objective To explore the risk factors tor acute kidney injury （AK1） in patients with acute myocardial infarction （AMI）. Method The medical data of hospitalized patients with AMI admitted from October 2013 to May 2014 were reviewed. All patients were divided into AKI group and non-AKI group. The univariate comparison analysis were performed to obtain the AKI risk factors. Results A total of 565 patients were enrolled. The incidence of AKI （n = 91 ） was 16. 1% and there were 474 non-AKI patients. The mortality of AKI group was 19.8% and mortality of non-AKI group was 0.4% （ P 〈0. 01 ）. Univariate analysis demonstrated that the risk factors of AKI were age, hypertension, previous myocardial infarction, heart failure history, chronic kidney disease, cerebral intarction history, peripheral vascular disease; ventricular fibrillation, heart rate, Killip grade ≥3 stage, left ventricular ejection fraction, serum creatinine, eGFR, hemoglobin, blood urea nitrogen, troponin I, B-type natriuretic peptide and C-reactive protein, fasting glucose, albumin, maximum daily dose of furosemide, non-use of ACEI/ARB and statins, the use of intra-aortie balloon pump, temporary pacemaker and pulmonary mechanical ventilation, implementation of PCI and coronary artery bypass graft surgery. Conclusions These risk factors for AKI after AMI were found to identify high-risk patients, helping the clinicians to make decision for preventive intervention.