血浆Hcy对急性心肌梗死患者PCI术后发生造影剂肾病的预测价值

Predictive value of Hcy on contrast-induced nephropathy after PCI in patients with acute myocardial infarction

目的探讨血浆同型半胱氨酸(Hcy)对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后发生造影剂肾病的预测价值。方法选取2014年1月至2015年12月于北京电力医院接受PCI术的156例AMI患者作为研究对象,并分为造影剂肾病组和非造影剂肾病组。比较两组患者的基线资料、围术期资料及辅助检查结果,采用单因素分析和多因素Logistics回归分析其影响因素。结果 156例患者PCI术后共出现32例造影剂肾病,发生率为20.5%。造影剂肾病组的血浆Hcy水平为(21.3±8.7)μmol/L,显著高于非造影剂肾病组(13.3±6.1)μmol/L,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,血浆Hcy水平是患者术后出现造影剂肾病的独立危险因素(OR=2.254,95%CI:1.359~3.737,P=0.002)。结论约1/5的AMI患者PCI术后发生造影剂肾病,术前血浆Hcy水平可较好地预测造影剂肾病的发生风险,值得临床推广应用。

Objective To investigate the predictive value of plasma homocysteine（Hcy）on contrast-induced nephropathy after percutaneous coronary intervention（PCI）in patients with acute myocardial infarction（AMI）.Methods Totally 156 patients with AMI receiving PCI in Beijing Electric Power Hospital from January 2014 to December 2015 were enrolled for the study and divided into contrast-induced nephropathy group and non-contrast-induced nephropathy group.Baseline data,perioperative data and auxiliary examination results were compared between two groups.The single factor analysis and multivariate Logistic regression were used to analyze the influencing factors.Results In all 156 patients,32 cases occurred contrast-induced nephropathy after PCI,and the incidence was 20.5%.The plasma Hcy level in contrast-induced nephropathy group was（21.3±8.7）μmol/L,significantly higher than（13.3±6.1）μmol/L in non-contrast-induced nephropathy group（P〈0.05）.Multiple Logistic regression analysis results showed that plasma Hcy levels was the independent risk factors of contrast-induced nephropathy（OR=2.254,95% CI：1.359-3.737,P=0.002）.Conclusion About 1/5 of patients with AMI occur contrast-induced nephropathy after PCI,and preoperative plasma Hcy level can well predict the risk of contrast-induced nephropathy,which is worthy of clinical application.