急性ST段抬高性心肌梗死患者发生急性肾损伤的危险因素

Risk factors of acute kidney injury in the patients with acute ST segment elevation myocardial infarction

目的调查急性ST段抬高性心肌梗死(STEMI)患者发生急性肾损伤(AKI)的发病率及病死率,筛查其发生AKI的危险因素。方法连续收集北京积水潭医院和北京大学人民医院2019年5月至2020年5月STEMI确诊病例进行回顾性研究,并分为AKI组及非AKI组,进行组间比较和回归分析,获得发生AKI相关危险因素。结果入选患者共566例,AKI发病率为25.6%(144/566),其中AKI组病死率为22.2%,非AKI组病死率为0.7%(P<0.001)。组间比较筛选出的变量包括年龄、性别、高血压、陈旧性心肌梗死、心力衰竭、慢性肾脏病,脑梗死史、周围血管病及吸烟史、广泛前壁心肌梗死、Killip分级≥Ⅲ级、心室颤动、心率、左室射血分数、血红蛋白、白细胞、血肌酐、估算肾小球滤过率(e GFR)、尿素氮、B型脑钠肽、C反应蛋白、空腹血糖、白蛋白、呋塞米最大日剂量、未使用β受体阻滞剂及他汀类药物、使用主动脉内球囊反搏、安置临时起搏器、未行冠状动脉介入治疗(PCI)及冠状动脉旁路移植手术和进行机械通气治疗等。将P<0.05的变量带入多元Logistic回归方程,结果显示,年龄[比值比(odds ratio,OR) 1.034,95%置信区间(confidence interval,CI)]1.018-1.049,P=0.000)、高血压(OR 3.185,95%CI 1.934-5.245,P=0.000)、慢性肾脏病(OR 3.68 1,95%CI 1.710-7.923,P=0.001)、广泛前壁心肌梗死(OR 2.562,95%CI 1.445-4.542,P=0.001)、心率(OR 1.034,95%CI 1.018-1.049,P=0.000)、未行PCI(OR 1.699,95%CI 1.063-2.716,P=0.032)是STEMI患者发生AKI的危险因素。结论分析STEMI后AKI的危险因素,有助于识别高危患者,早期采取预防措施,降低STEMI患者院内并发症及病死率。

Objective To investigate the morbidity and mortality of acute kidney injury (AKI) patients with acute ST segment elevation myocardial infarction( STEMI),and to screen risk factors of AKI. Methods Patients diagnosed with STEMI from May 2019 to May 2020 were enrolled and were divided into AKI group and non-AKI. The statistical analysis was performed to obtain the AKI risk factors. Results 566 patients were enrolled,of which 25. 6% patients had AKI,and AKI group’s mortality was 22. 2%,non-AKI group’s mortality was 0. 7%( P<0. 001). The variables were screened out by univariate analysis including age,gender,hypertension,previous myocardial infarction,heart failure history,chronic kidney disease,cerebral infarction history,surrounding vascular disease,smoking history,extensive anterior wall myocardial infarction,Killip grade≥Ⅲ stage,ventricular fibrillation,heart rate,left ventricular ejection fraction,hemoglobin,white blood cell,serum creatinine,e GFR,blood urea nitrogen,B-type natriuretic peptide and C-reactive protein,fasting glucose,albumin,maximum daily dose of furosemide,non-use of β receptor blockers and statins,the use of intra-aortic balloon pump,the placement of temporary pacemaker,non-implementation of PCI and coronary artery bypass grafting surgery,and pulmonary mechanical ventilation( P<0. 05). Logistic regression analysis showed that the independent risk factors for AKI in the patients with STEMI included age [odds ratio(OR)1. 034,95% confidence interval(CI 1. 018-1. 049,P = 0. 000),hypertension(OR 3. 185,95% CI1. 934-5. 245,P = 0. 000),chronic kidney disease(OR 3. 681,95% CI 1. 710-7. 923,P = 0. 001),extensive anterior myocardial infarction(OR 2. 562,95% CI 1. 445-4. 542,P = 0. 001),heart rate(OR) 1. 034,95% CI 1. 018-1. 049,P = 0. 000),non-implementation of PCI(OR 1. 699,95% CI1. 063-2. 716,P = 0. 032). Conclusions This study is helpful to identify high-risk patients,take early preventive intervention,and reduce the in-hospital complications and mortality of STEMI patients by the analysis of risk factors for AKI patients with STEMI.