ST段抬高型心肌梗死患者经皮冠脉介入术后发生造影剂肾病的影响因素分析

Influencing Factors of Contrast-Medium Nephropathy After Percutaneous Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction

目的分析ST段抬高型心肌梗死(STEMI)患者经皮冠脉介入术(PCI)后发生造影剂肾病(CIN)的影响因素。方法回顾性收集2018年1月至2020年1月于阜外华中心血管病医院接受PCI治疗的435例STEMI患者的临床资料。根据术后CIN发生情况将患者分为CIN组(60例)和非CIN组(375例)。比较两组患者临床资料,采用多因素logistic回归分析寻找CIN发生的独立影响因素,使用受试者工作特征(ROC)曲线分析上述因素对CIN的预测价值。结果多因素logistic回归分析显示,平均血小板体积与淋巴细胞比率(MPVLR)是STEMI患者PCI术后发生CIN的独立危险因素(OR=3.859,95%CI:2.465~6.040,P<0.001),此外年龄、糖尿病病史及造影剂用量也是CIN发生的独立危险因素(P<0.05),左室射血分数(LVEF)是CIN发生的独立保护因素(P<0.05)。ROC曲线显示,上述各因素对CIN的发生均有一定的预测能力,其中MPVLR的预测价值最高,曲线下面积(AUC)分别为0.769,截断值为4.22,预测CIN的敏感度和特异度分别为70.00%和70.40%。结论MPVLR、年龄、糖尿病病史、造影剂用量为STEMI患者PCI术后发生CIN的独立危险因素,术前LVEF是CIN发生的独立保护因素。MPVLR临床获取方便,可作为预测STEMI患者PCI术后CIN的潜在标志物。

Objective To analyze the influencing factors of contrast-induced nephropathy(CIN)in patients with ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods The clinical data of 435 STEMI patients who received PCI treatment in Fuwai Huazhong Cardiovascular Hospital from January 2018 to January 2020 were retrospectively collected.Patients were divided into CIN group(60 cases)and non-CIN group(375 cases)according to the postoperative CIN occurrence.The clinical data of the two groups of patients were compared,multivariate logistic regression analysis was used to find independent factors influencing the occurrence of CIN,and receiver operating characteristic(ROC)curves were used to analyze the predictive value of the above factors on CIN.Results Multivariate logistic regression analysis showed that mean platelet volume-to-lymphocyte ratio(MPVLR)was an independent risk factor for CIN in STEMI patients after PCI(OR=3.859,95%CI:2.465-6.040,P<0.001).In addition,age,diabetes history,and contrast agent dosage were also independent risk factors for CIN(P<0.05).Left ventricular ejection fraction(LVEF)was an independent protective factor for CIN(P<0.05).The ROC curve showed that the above factors all had a certain predictive ability for the occurrence of CIN.MPVLR had the highest predictive value.The area under the curve(AUC)was 0.769 and the cutoff value was 4.22.The sensitivity and specificity of predicting CIN were 70.00%and 70.40%,respectively.Conclusions MPVLR,age,diabetes history,and contrast agent dosage are independent risk factors for CIN in STEMI patients after PCI.Preoperative LVEF is an independent protective factor for CIN.MPVLR is easy to obtain clinically and could be used as a potential marker for predicting CIN in STEMI patients after PCI.