ACEF评分对急性心梗患者经皮冠状动脉介入术后发生急性肾损伤的预测价值

Value of ACEF Score in Predicting Acute Kidney Injury in Patients with Acute Myocardial Infarction After Percutaneous Coronary Intervention

目的探讨年龄-肌酐-射血分数(age-creatinine-ejection fraction,ACEF)评分对急性心肌梗死(acute myocardial infarction,AMI)患者经皮冠状动脉介入术(percutaneous coronary intervention,PCI)后发生造影剂引起的急性肾损伤(contrast-induced acute kidney injury,CI-AKI)的预测价值。方法回顾性分析2013-12-01/2018-12-31日作者医院收治的356例行PCI的AMI患者的临床资料,计算所有患者的ACEF评分,按照ACEF评分中位数将患者分为低分组(ACEF<1.055,n=178)及高分组(ACEF≥1.055,n=178),分析两组各项临床指标差异及CI-AKI发生率差异。采用单因素及多因素Logistic回归分析AMI患者发生CI-AKI的危险因素。绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析不同危险因素对预测AMI患者PCI后发生CI-AKI的灵敏度及特异度。结果356例AMI患者中CI-AKI发生人数为31人,总发生率为8.71%,其中高分组患者CI-AKI发生率显著高于低分组(12.36%vs.5.06%,P<0.05)。多因素Logistic回归分析结果显示高白细胞计数(white blood cell,WBC)、低血磷、高ACEF评分是AMI患者发生CI-AKI的独立危险因素。ROC曲线结果显示,ACEF评分对AMI患者发生CI-AKI的预测价值优于WBC及血磷。ACEF评分最佳截取值在1.19时,灵敏度为61.30%,特异度为66.20%。结论ACEF评分可以很好地预测AMI患者PCI术后CI-AKI的发生。

Objective To investigate the predictive value of age-creatinine-ejection fraction(ACEF)score for contrast-induced acute kidney injury(CI-AKI)in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods Clinical datas of 356 AMI patients with PCI admitted to author′s hospital from December 1,2013to December 31,2018 were retrospectively analyzed,ACEF scores of all patients were calculated,and patients were divided into low score group(ACEF<1.055,n=178)and high score group(ACEF≥1.055,n=178),the differences of clinical indicators and incidence of CI-AKI between the two groups were analyzed.The risk factors of CIAKI in AMI patients were analyzed by univariate and multivariate Logistic regression analysis.Receiver operating characteristic(ROC)curve was drawn to analyze the sensitivity and specificity of different risk factors in predicting the occurrence of CI-AKI after PCI in AMI patients.Results Among 356 AMI patients,31 had CI-AKI,with a total incidence of 8.71%,and the incidence of CI-AKI in high score group was significantly higher than that in low score group(12.36%vs.5.06%,P<0.05).Multivariate Logistic regression analysis showed that high white blood cell(WBC),low blood phosphorus and high ACEF score were independent risk factors for CI-AKI in AMI patients.ROC curve results showed that ACEF score was better than WBC and blood phosphorus in predicting CI-AKI in AMI patients.The best cut-off value of ACEF score was 1.19,the sensitivity was 61.30%and the specificity was 66.20%.Conclusion ACEF score can well predict the incidence of CI-AKI in AMI patients after PCI.