尿调节素和葡萄糖-6-磷酸脱氢酶对急性心肌梗死患者PCI后发生急性肾损伤的预测价值

Predictive Value of Uromodulin and Glucose-6-Phosphate Dehydrogenase for Acute Kidney Injury after PCI in Patients with Acute Myocardial Infarction

目的探讨尿调节素(UMOD)、葡萄糖-6-磷酸脱氢酶(G6PD)对急性心肌梗死患者PCI后发生急性肾损伤(AKI)的预测价值。方法选取2021年2月—2023年2月在新疆医科大学第一附属医院心脏中心监护病房行PCI的急性心肌梗死患者285例,根据PCI后是否发生AKI将其分为AKI组(n=26)和非AKI组(n=259)。比较两组一般资料、LVEF、血压、实验室检查指标及病情和治疗情况。急性心肌梗死患者PCI后发生AKI的影响因素分析采用多因素Logistic回归分析;绘制ROC曲线以评价UMOD、G6PD及二者联合对急性心肌梗死患者PCI后发生AKI的预测价值。结果两组合并肾功能不全者占比、LVEF、WBC、血肌酐、估算肾小球滤过率(eGFR)、尿酸、UMOD、G6PD及病变血管支数比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,肾功能不全、LVEF<50%、血肌酐≥100μmol/L、尿酸≥420μmol/L、UMOD<120 mg/L、G6PD<8 U/gHb是急性心肌梗死患者PCI后发生AKI的危险因素(P<0.05)。ROC曲线分析结果显示,UMOD、G6PD及二者联合预测急性心肌梗死患者PCI后发生AKI的AUC分别为0.781[95%CI(0.702~0.861)]、0.771[95%CI(0.689~0.853)]、0.888[95%CI(0.831~0.944)]。结论UMOD<120 mg/L、G6PD<8 U/gHb是急性心肌梗死患者PCI后发生AKI的危险因素,二者联合对急性心肌梗死患者PCI后发生AKI具有一定预测价值。

Objective To investigate the predictive value of uromodulin(UMOD)and glucose-6-phosphate dehydrogenase(G6PD)for acute kidney injury(AKI)after PCI in patients with acute myocardial infarction.Methods A total of 285 patients with acute myocardial infarction who underwent PCI in the Coronary Care Unit,the First Affiliated Hospital of Xinjiang Medical University from February 2021 to February 2023 were selected and divided into AKI group(n=26)and non-AKI group(n=259)according to whether AKI occurred after PCI.The general data,LVEF,blood pressure,laboratory examination indexes and state of anillness and treatment condition were compared between the two groups.Multivariate Logistic regression analysis was used to analyze the influencing factors of AKI after PCI in patients with acute myocardial infarction.ROC curve was drawn to evaluate the predictive value of UMOD,G6PD and their combination for AKI after PCI in patients with acute myocardial infarction.Results There were significant differences in the proportion of patients with renal dysfunction,LVEF,WBC,serum creatinine,estimated glomerular filtration rate(eGFR),uric acid,UMOD,G6PD and the number of vascular lesions between the two groups(P<0.05).Multivariate Logistic regression analysis showed that renal dysfunction,LVEF<50%,serum creatinine≥100μmol/L,uric acid≥420μmol/L,UMOD<120 mg/L,G6PD<8 U/gHb were risk factors for AKI after PCI in patients with acute myocardial infarction(P<0.05).ROC curve analysis results showed that the AUC of UMOD,G6PD and their combination in predicting AKI after PCI in patients with acute myocardial infarction was 0.781[95%CI(0.702-0.861)],0.771[95%CI(0.689-0.853)]and 0.888[95%CI(0.831-0.944)],respectively.Conclusion UMOD<120 mg/L and G6PD<8 U/gHb are risk factors for AKI after PCI in patients with acute myocardial infarction.The combination of the two has a certain predictive value for AKI after PCI in patients with acute myocardial infarction.