STEMI患者PCI治疗后心脏功能参数对造影剂肾病风险的预测价值

Predictive value of postoperative cardiac function parameters on contrast-induced nephropathy in patients with STEMI after percutaneous coronary intervention

目的探讨将心脏功能参数用于经皮冠状动脉介入(percutaneou coronary intervention,PCI)治疗患者术后造影剂肾病(contrast-induced nephropathy,CIN)的诊断价值。方法选择2015年5月至2016年12月成武县人民医院心血管内科接受PCI治疗的急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者127例作为前瞻性观察研究对象。在所有患者PCI造影术后24h内采用床旁超声诊断仪检测心脏收缩及舒张功能参数。通过Logistic回归分析评估心脏功能参数对CIN风险的预测价值。结果在纳入的127例接受PCI造影术的STEMI患者中,有17例术后发生CIN,发生率为13.4%。与没有发生CIN的患者相比,CIN患者中造影剂使用体积≥400mL的患者比例显著增多,并且血清氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)浓度和血糖浓度均显著升高,差异有统计学意义(P<0.05)。单因素分析显示,CIN发生与二尖瓣瓣尖舒张早期最大血流速度(E)/二尖瓣环速度(E′)、左心室射血分数、NT-ProB.NP显著相关(P<0.05);进一步多因素分析结果显示E/E′与CIN的发生独立相关(P<0.05)。受试者工作特征曲线(receiver operating characteristic curve,ROC)分析结果显示,E/E′>15对检测CIN的灵敏度和特异性分别为72%和80%,曲线下面积为0.871。结论E/E′>15是STEMI患者PCI治疗后CIN的重要独立预测因子。

Objectives To evaluate the diagnostic value of cardiac function parameters on postoperative contrastinduced nephropathy(CIN)in patients after primary percutaneous coronary intervention(PCI).Methods We prospectively investigated 127 consecutive consenting patients with ST-segment elevation myocardial infarction(STEMI) who were given primary PCI from May 2015 to December 2016 in Chengwu County People′s Hospital.Systolic and diastolic parameters within 24 hours of PCI were measured by bedside ultrasound diagnostic instrument.Predictive value of cardiac function parameters for the risk of CIN was assessed using Logistic regression.Results Among the 127 patients with STEMI after PCI,17(13.4%)patients occurred CIN.Compared with patients without CIN,percentage of patients with contrast media using volume ≥ 400 mL was significantly higher in CIN patients(P<0.05),and serum con.centrations of N-terminal pro-brain natriuretic peptide(NT-proBNP)and blood glucose were significantly higher too(P< 0.05).Univariate analysis showed that CIN had a significant correlation with peak blood velocity in early diastolic phase of mitral valve cusp(E)/mitral annulus velocity(E′),left ventricular ejection fraction and NT-proBNP(P<0.05).Further multivariate analysis showed that E/E′ was independently associated with CIN(P<0.05).The results of receiver operating characteristic curve(ROC)analysis showed that the sensitivity and specificity of E/E/′ ratio>15 to CIN were 72% and 80%,respectively,and the area under the curve was 0.871.Conclusions E/E′ ratio>15 was a significant and independent predictor of CIN after primary PCI in patients with STEMI.