中性粒细胞绝对值、尿肾损伤分子1与经皮冠状动脉介入治疗后缺血再灌注急性肾损伤的相关性

Relationship between absolute neutrophil count,urinary kidney injury molecule 1 and acute kidney injury after ischemia-reperfusion after PCI

目的探讨中性粒细胞绝对值(ANC)、尿肾损伤分子1(KMI-1)与急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后缺血再灌注急性肾损伤(AKI)的相关性。方法纳入行PCI的114例AMI患者为研究对象,根据患者PCI术后72 h内是否发生AKI分为AKI组和非AKI组。比较两组一般资料、PCI后2 h的ANC、尿KMI-1与其他实验室指标,分析ANC、尿KMI-1与AMI患者PCI后缺血再灌注AKI的关系。记录患者术后3个月心血管不良事件,分析ANC、尿KMI-1水平与心血管不良事件发生的关系。结果AKI组病变冠状动脉支数≥3支占比、ANC、C反应蛋白(CRP)、肌酐(Cr)、尿KMI-1水平均高于非AKI组,淋巴细胞绝对值(ALC)低于非AKI组,差异有统计学意义(Z=3.50,t分别=3.67、2.12、6.24、8.36、2.96,P均<0.05)。经logistic回归分析结果显示,ANC、Cr、尿KMI-1与AMI患者PCI后缺血再灌注AKI有关(OR分别=5.04、1.32、1.36,P均<0.05);ANC、尿KMI-1单独及联合模型预测的曲线下面积(AUC)为0.74、0.91、0.93。随访3个月发现,随着ANC、尿KMI-1升高,PCI后短期MACE发生率也随着升高(χ^(2)分别=13.77、9.36,P均<0.05)。结论ANC、尿KMI-1与AMI患者行PCI后缺血再灌注AKI有关,同时可提示AMI患者行PCI后短期预后情况,其机制与炎症反应有关。

Objective To investigate the correlation between absolute neutrophil count(ANC),urinary kidney injury molecule-1(KMI-1)and acute kidney injury(AKI)after ischemia-reperfusion after percutaneous coronary intervention(PCI)in acute myocardial infarction(AMI)patients.Methods Totally 114 AMI patients who underwent PCI were included as the study subjects,and they were divided into AKI group and non AKI group according to the occurrence of AKI within 72 hours after PCI.The general data,ANC,urinary KMI-1 and other laboratory indexes in 2h after PCI were compared between the two groups,and the relationships between ANC,urinary KMI-1 and ischemia-reperfusion AKI after PCI in AMI patients were analyzed.Cardiovascular adverse events were recorded in 3 months after operation,and the relationships between ANC and urinary KMI-1 levels and cardiovascular adverse events were analyzed.Results The proportion of coronary artery branches≥3,ANC,C-reactive protein(CRP),and creatinine(Cr)level and urinary KMI-1 in the AKI group were higher than those in the non AKI group,and the absolute value of lymphocytes(ALC)was lower than that in the non AKI group,with statistically significant differences(Z=3.50,t=3.67,2.12,6.24,8.36,2.96,P<0.05).Logistic regression analysis showed that ANC,Cr and urinary KMI-1 were related to ischemia-reperfusion AKI in AMI patients after PCI(OR=5.04,1.32,1.36,P<0.05).The areas under the curve(AUC)of ANC,urinary KMI-1,combined detection were 0.74,0.91,0.93,respectively.After a 3-month follow-up,it was found that as the ANC and urinary KMI-1 increased,the short-term MACE incidence rate after PCI also increased(χ^(2)=13.77,9.36,P<0.05).Conclusion ANC and urinary KMI-1 are related to ischemia-reperfusion AKI in AMI patients after PCI,and can indicate the short-term prognosis of AMI patients after PCI.The mechanism is related to inflammatory response.