预后营养指数对急性心肌梗死患者介入术后发生急性肾损伤的预测价值分析

Analysis of the prediction value of prognostic nutritional index for acute kidney injury after percutaneous coronary intervention in acute myocardial infarction

目的:探究预后营养指数(prognostic nutritional index,PNI)对急性心肌梗死(acute myocardial infarction,AMI)患者PCI术后发生急性肾损伤(acute kidney injury,AKI)的预测价值分析。方法:纳入2022年4月至2023年4月收治于我院的160例明确诊断为AMI且急诊行PCI术患者。根据术后是否发生AKI,将患者分为对照组(n=98)和AKI组(n=62)。收集所有患者的年龄、性别、体质量、吸烟史、疾病史(包括高血压和糖尿病)、心脏超声检查、淋巴细胞计数(lymphocyte,LYM)、血白蛋白(albumin,ALB)、TC、TG、HGB、SCr、估算的肾小球滤过率(estimated glomerular filtration rate,eGFR)、BUN、NT-proBNP和CK-MB,计算PNI。利用多因素Logistic回归分析AMI患者PCI术后发生AKI的影响因素。采用受试者工作特征(ROC)曲线分析PNI对AMI患者PCI术后发生AKI的预测价值。结果:与对照组相比,AKI组患者的LVEF水平显著较低[(50.3±5.4)%vs.(58.4±7.1)%,P<0.001],ALB[(36.2±4.4)vs.(41.1±4.7) g/L,P<0.001]、HGB[(121.9±14.4)vs.(131.5±16.3) g/L,P<0.001]、LYM[(1.4±0.6)vs.(1.7±0.7)×10^(9)/L,P<0.001]及PNI评分[(44.6±4.6)vs.(49.4±6.3)分,P<0.001]显著较低,SCr[(0.055±0.012)vs.(0.061±0.018)μmol/L,P<0.05]、NT-proBNP[(1 219±310)vs.(2 941±1 429)ng/L,P<0.001]和CK-MB[(38.1±11.9)vs.(46.4±13.5)μg/L,P<0.001]水平显著较高;多因素Logistic回归分析显示ALB降低、HGB降低、LYM降低、SCr升高、NT-proBNP升高、CK-MB升高、LVEF下降和PNI评分下降均为AMI患者PCI术后发生AKI的危险因素(OR>1,P<0.05);ROC曲线结果显示,PNI评分的AUC为0.848(95%CI:0.791~0.905,P<0.001),当PNI评分为37.5分时,其敏感度为57.1%,特异度为98.40%。结论:PNI对于AMI患者PCI术后发生AKI具有较好预测价值,可为临床实践及时监测和评估PCI术后AKI风险提供全新预测指标。

Objective:To demonstrate the prediction value of the prognostic nutritional index(PNI)for acute kidney injury(AKI)after PCI in patients with acute myocardial infarction(AMI).Methods:A total of 160 patients with AMI who underwent emergency PCI in our hospital from April 2022 to April 2023 were enrolled.Based on the occurrence of AKI after the procedure,patients were divided into control group(n=98)and AKI group(n=62).The clinical data included age,gender,body weight,smoking history,medical history(including hypertension and diabetes),echocardiography,lymphocyte count(LYM),serum albumin(ALB),TC,TG,HGB,SCr,estimated glomerular filtration rate(eGFR),blood urea nitrogen(BUN),NT-proBNP,and CK-MB were collected.The PNI was calculated.Multivariate Logistic regression analysis was performed to determine the factors influencing the occurrence of AKI after PCI in AMI patients.Receiver operator characteristic(ROC)curve analysis was used to assess the prediction value of PNI for the occurrence of AKI in AMI patients after PCI.Results:Compared with the control group,the level of LVEF in AKI group was significantly lower,(50.3±5.4)%vs.(58.4±7.1)%(P<0.001).ALB(36.2±4.4)vs.(41.1±4.7)g/L(P<0.001),HGB(121.9±14.4)vs.(131.5±16.3)g/L(P<0.001),LYM(1.4±0.6)vs.(1.7±0.7)×10^(9)/L(P<0.001)and PNI score(44.6±4.6)vs.(49.4±6.3)score(P<0.001)were significantly lower.SCr(0.055±0.012)vs.(0.061±0.018)μmol/L(P<0.05),NT-proBNP(1219±310)vs.(2941±1429)ng/L(P<0.001)and CK-MB(38.1±11.9)vs.(46.4±13.5)μg/L(P<0.001)levels were significantly higher.The multivariate Logistic regression analysis showed that decreased ALB,decreased HGB,decreased LYM,increased SCr,increased NT-proBNP,increased CK-MB,decreased LVEF,and decreased PNI score were all independent risk factors for AKI in AMI patients after PCI(OR>1,P<0.05).The ROC curve results showed that the AUC of PNI score was 0.848(95%CI:0.791-0.905,P<0.001),with a sensitivity of 57.10%and specificity of 98.40%when the PNI score was 37.49.Conclusions:PNI has excellent prediction value for the occurrence of AKI after PCI in AMI patients,providing a new predictive indicator for timely monitoring and assessment of the risk of AKI after PCI in clinical practice.