急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗后发生对比剂肾病相关因素分析

Analysis of factors associated with the occurrence of contrast induced nephropathy after emergency percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

目的:探讨急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)后发生对比剂肾病(contrast induced nephropathy,CIN)的相关因素。方法:回顾性选取2019年1月—2021年12月于汕头大学医学院第一附属医院行急诊PCI的905例STEMI患者作为研究对象,根据PCI后是否发生CIN,将患者分为CIN组(n=54)和non-CIN组(n=851)。采用logistic回归分析CIN发生的相关因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under curve,AUC)评价相关因素对CIN的预测价值。结果:STEMI患者急诊PCI后CIN发生率为6.0%(54/905)。多因素logistic回归分析表明,年龄(OR=1.043,95% CI:1.013~1.073,P=0.004)、心衰(OR=2.550,95% CI:1.413~4.600,P=0.002)、血尿酸(OR=1.003,95% CI:1.000~1.005,P=0.020)是STEMI患者行急诊PCI后发生CIN的相关因素。ROC曲线分析显示,年龄、心衰的AUC (95%CI)分别为0.681 (0.615,0.747)、0.643 (0.564,0.722)。结论:年龄、心衰、血尿酸可能是STEMI患者急诊PCI后发生CIN的相关因素,其中年龄和心衰对发生CIN有一定的预测价值。

Objective:To investigate the factors associated with the occurrence of contrast induced nephropathy(CIN)after emergency percutaneous coronary intervention(PCI)in patients with ST-segment elevation myocardial infarction(STEMI).Methods:905 STEMI patients who underwent emergency PCI at the First Affiliated Hospital of Shantou University Medical College from January 2019 to December 2021 were retrospectively selected as the study subjects,and the patients were divided into the CIN group(n=54)and the non-CIN group(n=851)according to whether CIN occurred after PCI.Logistic regression was used to analyze the factors associated with the occurrence of CIN,and the area under curve(AUC)of the receiver operating characteristic(ROC)of the subjects was used to evaluate the predictive value of the associated factors for CIN.Results:The incidence of CIN after emergency PCI in STEMI patients was 6.0%(54/905).Multivariate logistic regression analysis showed that age(OR=1.043,95%CI:1.013-1.073,P=0.004),heart failure(OR=2.550,95%CI:1.413-4.600,P=0.002),blood uric acid(OR=1.003,95%CI:1.000-1.005,P=0.020)were associated with the occurrence of CIN after emergency PCI in STEMI patients.ROC curve analysis showed that the AUC(95%CI)for age and heart failure were 0.681(0.615,0.747)and 0.643(0.564,0.722),respectively.Conclusion:Age,heart failure,and blood uric acid may be correlates of the occurrence of CIN after emergency PCI in patients with STEMI,with age and heart failure having some predictive value for the occurrence of CIN.