急性心肌梗死后急性肾损伤的危险因素分析

Risk factors for acute kidney injury after acute myocardial infarction

目的探讨急性心肌梗死(AMI)后急性肾损伤(AKI)的危险因素。方法选取AMI患者204例,根据是否发生AKI将患者分成AKI组(89例)和非AKI组(115例),记录两组患者的临床资料、实验室检查结果、治疗及预后情况,分析AMI后AKI的危险因素。结果与非AKI组比较,AKI组年龄较大,糖尿病、脑卒中和慢性肾脏病比例较高,入院时心律失常发生率高(P<0.05)。与非AKI组比较,AKI组WBC、中性粒细胞、红细胞分布宽度(RDW)、尿蛋白及尿红细胞阳性比例、FBG、BUN、SCr、尿酸、磷、脑钠肽(BNP)、超敏C反应蛋白较高,RBC、Hb、红细胞比容、白蛋白、TG、载脂蛋白A、前白蛋白、肾小球滤过率估值均较低(P<0.05)。AKI组左心室射血分数较非AKI组低,左心房内径较大(P<0.05)。与非AKI组比较,AKI组住院天数延长,利尿剂及抗生素使用率高,好转率低,自动出院率和死亡率高(P<0.05)。多因素Logistic回归分析显示,既往有糖尿病史、高RDW和高BNP是AMI后AKI的独立危险因素(P<0.05)。结论既往有糖尿病史、高RDW、高BNP是AMI后AKI的独立危险因素,有助于识别高危患者,早期采取干预措施。

Objective To investigate the risk factors for acute kidney injury(AKI)after acute myocardial infarction(AMI).Methods According to whether AKI occurred,204patients with AMI were divided into groups of A (with AKI,89cases)and B (without AKI,115cases).The clinical data,laboratory test results,treatment and prognosis were recorded.The risk factors of AKI after AMI were analyzed.Results Compared to group B,the patients in group A had older age,higher percentages of diabetes,stroke and chronic kidney disease and the incidence of arrhythmia on admission(P<0.05).The WBC,neutrophils,erythrocyte distribution width(RDW),positive ratio of urinary protein and red blood cell,FBG,BUN,SCr,uric acid,phosphorus,brain natriuretic peptide (BNP)and high sensitive C-reactive protein were higher and the RBC,Hb,erythrocrit,albumin,TG, lipoprotein A,prealbumin and estimation of glomerular filtration rate were lower in group A than those in group B(P<0.05).The left ventricular ejection fraction was lower and left atrial diameter was bigger in group A than those in group B(P<0.05).Compared to group B,the hospital stay was prolonged,the percentages of patients using diuretics and antibiotics were higher,the improvement rate was lower and the rate of automatic discharge and mortality were higher in group A(P<0.05). Multivariate Logistic regression analysis showed that the history of diabetes mellitus,high RDW and high BNP were the independent risk factors for AKI after AMI(P<0.05).Conclusion The history of diabetes mellitus,high RDW and high BNP are the independent risk factors for AKI after AMI, which can help to identify the high-risk patients and take the interventions in the early stage of AKI.