三种代谢产物对老年急性心肌梗死患者发生肾损伤的预测价值

Predictive value of three metabolites for acute kidney injury in elderly patients with acute myocardial infarction

目的探讨老年急性心肌梗死(AMI)患者入院时血浆葡萄糖酸、富马酸和假尿苷联合预测急性肾损伤(AKI)的价值。方法收集2021年12月至2022年7月中国医学科学院阜外医院急诊科转入冠心病重症监护室治疗的老年AMI患者78例,根据住院期间AKI发生情况分为AKI组40例和非AKI组38例。采用液相色谱串联质谱定量分析AMI患者入院时血浆葡萄糖酸、富马酸和假尿苷水平。采用ROC曲线下面积(AUC)确定3种血浆代谢产物预测AMI患者发生AKI的价值。采用多因素logistic回归分析AKI的临床危险因素。结果AKI组与非AKI组血浆葡萄糖酸、富马酸和假尿苷水平比较,差异无统计学意义(P>0.05)。ROC曲线分析显示,葡萄糖酸、富马酸和假尿苷对老年AMI患者AKI发生无预测价值(AUC=0.576,95%CI:0.449~0.704,P=0.246;AUC=0.595,95%CI:0.467~0.721,P=0.154;AUC=0.563,95%CI:0.435~0.692,P=0.337)。多因素logistic回归分析显示,左心室射血分数(LVEF)是老年AMI患者发生AKI的独立预测因素(OR=0.923,95%CI:0.870~0.978,P=0.007)。结论老年AMI患者血浆葡萄糖酸、富马酸和假尿苷不能早期预测AKI发生,而LVEF是老年AMI患者发生AKI的独立预测因素。

Objective To investigate the predictive value of combined plasma gluconic acid(GA),fumaric acid(FA),and pseudouridine levels at admission for acute kidney injury(AKI)in elderly patients with acute myocardial infarction(AMI).Methods A total of 78elderly AMI patients transferred from Emergency Department to Coronary Care Unit in Fuwai Hospital during December 2021and July 2022were enrolled in this prospective study.They were divided into AKI group(40cases)and non-AKI group(38cases)according to whether they developed AKI during hospitalization.Plasma levels of GA,FA and pseudouridine were quantitatively detected with liquid chromatography-tandem mass spectrometry.ROC curve was plotted to assess the predictive value of these three plasma metabolites for AKI in AMI patients.Multivariate logistic regression analysis was applied to analyze the clinical risk factors for AKI.Results There were no statistical differences in the plasma levels of GA,FA and pseudouridine between the AKI group and the non-AKI group(P>0.05).ROC curve analysis revealed that the plasma levels of the three indicators had no predictive value for the development of AKI in elderly AMI patients(AUC=0.576,95%CI:0.449-0.704,P=0.246;AUC=0.595,95%CI:0.467-0.721,P=0.154;AUC=0.563,95%CI:0.435-0.692,P=0.337).Multivariate logistic regression analysis revealed that left ventricular ejection fraction(LVEF)was an independent predictor for AKI development in elderly AMI patients(OR=0.923,95%CI:0.870-0.978,P=0.007).Conclusion Plasma GA,FA and pseudouridine cannot predict the development of AKI in elderly AMI patients,while,LVEF is an independent predictor for the development.