心率变异性与急性前壁心肌梗死并发急性肾损伤的关系

Relationship between heart rate variability and acute anterior myocardial infarction complicated with acute kidney injury

目的:探讨采用心率变异性在评估急性前壁心肌梗死(AMI)期间是否发生急性肾损伤(AKI)及判断患者预后的价值。方法:选择2012年12月至2016年12月期间60例急性心肌梗死患者为研究对象,根据AKI诊断标准将患者分为非AKI组和AKI组,并根据AKI治疗后是否好转分为好转组和无效组,计算各组患者心率变异性(HRV)。结果:随访期间,共26例发生AKI,AKI发生率为43.33%,AKI组患者HRV各指标均低于非AKI组(P<0.05);经血透和药物治疗后,19例合并AKI患者治疗后好转,7例治疗无效,两组患者HRV指标比较差异有统计学意义(P<0.05);ROC曲线显示,HRV中的低频(LF)和高频(HF)对AMI合并AKI的预测值即曲线下面积(AUC)为0.847和1.914(P<0.05)。结论:HRV可以作为评估急性心肌梗死时合并急性肾损伤的指标,其具有重要的临床价值。

Objective:To study whether evaluation by heart rate variability(HRV)will make acute kidney injury(AKI)occur during acute anterior myocardial infarction(AMI)and its prognostic value.Methods:60 patients with AMI from Dec.2012 to Dec.2016 were chosen and divided into the non-AKI group and the AKI group according to the diagnostic standard of AKI and they were further divided into the improved group and the non-improved group after treatment,with HRV calculated.Results:There were 26 cases of AKI during the follow-up,the incidence rate being 43.33%.The indices of patients with HRV in the AKI group were significantly lower than those of the non-AKI group(P<0.05).After hemodialysis and drug therapy,19 cases of AKI were improved after treatment while 7 cases were not improved,there being significant difference in HRV indices between the two groups(P<0.05).ROC curves showed that the area under curve(AUC)of low frequency(LF)and high frequency(HF)for AMI complicated with AKI were 0.847 and 1.914 respectively(P<0.05).Conclusion:The sympathetic nervous system activity can be used as the assessment of AMI complicated with AKI indices,which has important clinical value.