急性ST段抬高型心肌梗死经皮冠状动脉介入治疗后急性肾损伤的预测因素

Predictors of acute kidney injury after percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

目的探讨急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后并发急性肾损伤(AKI)的危险因素。方法回顾性分析深圳市第三人民医院2017年1月至2020年12月收治的行急诊PCI术的150例STEMI患者的临床资料,根据住院期间是否发生AKI分为AKI组22例和非AKI组128例,比较两组患者的一般资料和实验室指标,采用多因素Logistic回归分析AKI发生的危险因素,运用受试者工作特征曲线(ROC)评估外周血中性粒细胞与淋巴细胞比值(NLR)预测AKI的价值。结果STEMI急诊PCI术后AKI发生率14.67%。AKI组患者的NLR值为6.180(4.171,8.199),明显高于非AKI组的3.807(1.714,6.033),差异有统计学意义(P<0.05);AKI组和非AKI组患者的外周血中性粒细胞计数[9.385(6.753,12.430)×10^(9)/L vs 7.645(5.525,10.610)×10^(9)/L]、峰值血肌酐[117.50(106.75,157.25)μmol/L)vs 78.50(68.00,92.00)μmol/L)]、尿素[5.550(3.850,6.987)μmol/L vs 4.450(3.600,5.453)μmol/L)]、峰值肌钙蛋白I[(45.59±8.29)μg/L vs(38.14±10.53)μg/L]、峰值N末端B型利钠肽原(NT-proBNP)[1274.00(632.50,8080.00)ng/mL vs 529.00(326.50,886.00)ng/mL]比较,AKI组明显高于非AKI组,差异均有统计学意义(P<0.05);AKI组患者的外周血淋巴细胞计数为1.700(1.162,2.000)×10^(9)/L,明显低于非AKI组的2.175(1.425,3.255)×10^(9)/L,差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示,NLR(OR=7.746;95%CI:1.488~40.323;P=0.015)、峰值肌钙蛋白I(OR=27.707;95%CI:3.158~243.101;P=0.003)、峰值NT-proBNP(OR=4.208;95%CI:1.160~15.263;P=0.029)是STEMI患者急诊PCI术后AKI发生的独立危险因素;经ROC曲线分析结果显示,NLR预测AKI的曲线下面积为0.91。结论急诊PCI治疗的STEMI患者中AKI发病率较高,NLR、峰值肌钙蛋白I、峰值NT-proBNP可能是AKI发生的独立预测因子。

Objective To investigate the risk factors for the complication of acute kidney injury(AKI)in patients with acute ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods A retrospective analysis was performed on 150 STEMI patients who were admitted to Shenzhen Third People's Hospital from January 2017 to December 2020 and underwent emergency PCI.According to whether AKI occurred during hospitalization,the patients were divided into AKI group(n=22)and non-AKI group(n=128).The general information and laboratory indicator were collected and compared.Multivariate logistic regression analyses were performed to identify the independent risk factors of CI-AKI.The ROC curve was used to evaluate the value of NLR in predicting AKI.Results The incidence of AKI after emergency PCI in STEMI patients was 14.67%.Compared with the non-AKI group,the following indexes in the AKI group were significantly higher(P<0.05):NLR,6.180(4.171,8.199)vs 3.807(1.714,6.033);the neutrophil count,9.385(6.753,12.430)×10^(9)/L vs 7.645(5.525,10.610)×10^(9)/L;the peak blood creatinine,117.50(106.75,157.25)μmol/L vs 78.50(68.00,92.00)μmol/L;the urea,5.550(3.850,6.987)μmol/L vs 4.450(3.600,5.453)μmol/L;the peak troponin I,(45.59±8.29)μg/L vs(38.14±10.53)μg/L;the peak NT-proBNP,1274.00(632.50,8080.00)ng/mL vs 529.00(326.50,886.00)ng/mL.The peripheral blood lymphocyte count in the AKI group was significantly lower than that in the non-AKI group:1.700(1.162,2.000)×10^(9)/L vs 2.175(1.425,3.255)×10^(9)/L,P<0.05.Multivariate logistic regression analysis showed that NLR(OR=7.746;95%CI:1.488-40.323;P=0.015),the peak troponin I(OR=27.707;95%CI:3.158-243.101;P=0.003),the peak NT-proBNP(OR=4.208;95%CI:1.160-15.263;P=0.029)were independent predictors of AKI in STEMI patients undergoing primary PCI.ROC curve analysis showed that the area under the curve of NLR for predicting AKI was 0.91.Conclusion The incidence of AKI is relatively high in STEMI patients undergoing primary PCI.NLR,the peak troponin I,and the peak NT-proBNP may be independent predictors of AKI.