老年急性心肌梗死后肾功能不全患者临床特征及相关危险因素分析

Analysis of clinical characteristics and related risk factors in elderly patients with renal insufficiency after acute myocardial infarction

目的探讨老年急性心肌梗死(AMI)后肾功能不全患者的临床特征及危险因素。方法回顾性分析2017年9月—2020年4月入住复旦大学附属华东医院心血管重症监护室的老年AMI患者资料。根据估算的肾小球滤过率(eGFR),将376例患者分为肾功能无明显下降组和中重度肾功能不全组。收集患者的临床基线信息、实验室检查指标、超声心动图参数及冠状动脉造影结果,并进行统计学分析和比较。结果共376例老年AMI患者,年龄60~106岁,平均(74.9±9.5)岁,其中肾功能无明显下降组243例(64.63%),中重度肾功能不全组133例(35.37%)。2组的年龄、心率、呼吸、发病至入院时间、高血压史、吸烟史、饮酒史及Killip分级差异有统计学意义。多因素Logistic回归分析提示,高龄、红细胞沉降率(ESR)加快、血尿酸(UA)增高和贫血可能是老年AMI后肾功能不全的影响因素。老年AMI后肾功能不全的预测模型为:Y=e^(X)/(1+e^(X)),X=-13.2+0.116×Age+0.017×ESR+0.017×UA-0.024×HB,其敏感度为83.50%,特异度为84.00%。结论高龄、ESR加快、UA增高和贫血可能是老年AMI后肾功能不全的危险因素。

Objective To investigate the clinical characteristics and risk factors in the elderly patients with renal insufficiency after acute myocardial infarction(AMI).Methods The data of elderly AMI patients admitted to the Cardiovascular Intensive Care Unit of Huadong Hospital Affiliated to Fudan University from September 2017 to April 2020 were retrospectively analyzed.According to the estimated glomerular filtration rate(eGFR),376 patients were divided into no significant decline in renal function group and moderate to severe renal insufficiency group.Their clinical baseline information,laboratory examination indexes,echocardiographic parameters and coronary angiography results were collected and compared.Results A total of 376 patients aged 60-106 years,with a mean age of(74.9±9.5)years,were included in this study.There were 243 ones(64.63%)in no significant decline in renal function group and 133 ones(35.37%)in moderate to severe renal insufficiency group.There were significant differences in age,heart rate,respiration,time from onset to admission,history of hypertension,smoking history,drinking history and Killip classification between the two groups.Multivariate logistic regression analysis suggests that,Advanced age,accelerated erythrocyte sedimentation rate(ESR),increased serum uric acid(UA)and anemia were the influencing factors of renal insufficiency after AMI in the elderly.The prediction model of elderly patients with renal insufficiency after AMI was:Y=e^(X)/(1+e^(X)),X=-13.2+0.116×Age+0.017×ESR+0.017×UA-0.024×HB,and its sensitivity and specificity were 83.50%and 84.00%,respectively.Conclusion Advanced age,accelerated ESR,increased UA and anemia may be the risk factors of renal insufficiency after AMI in the elderly.