急性心肌梗死合并急性肾损伤的危险因素分析

The Analysis for Risk Factors of Acute Myocardial Infarction Combined with Acute Renal Injury

目的探讨急性心肌梗死(AMI)患者发生急性肾损伤(AKI)的危险因素。方法 AMI患者728例,分为AKI组和非AKI组。比较两组患者的临床资料,分析AMI患者发生AKI的独立危险因素,观察急诊冠状动脉介入治疗(PCI)对AMI患者发生AKI的影响。结果 728例AMI患者中发生AKI共152例(20.9%)。AKI组与非AKI组比较,年龄、糖尿病史、平均动脉压、收缩压、心率、心功能(Killip分级)、左心室射血分数、基础肾小球滤过率估计值、ST段抬高型心肌梗死、服用β-受体阻滞剂以及血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂等指标差异具有统计学意义(P<0.01)。多因素Logistic分析显示,年龄、糖尿病史、入院收缩压、心功能分级、左心室射血分数、基础肾小球滤过率估计值、未服用血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂是AMI患者发生AKI的独立危险因素。378例ST段抬高型心肌梗死,其中256例接受急诊PCI,统计分析显示未接受急诊PCI患者的AKI发生率显著高于急诊PCI患者(39.3%比19.5%,P<0.01)。结论 AKI是AMI常见的并发症,其发生与多种因素有关,急诊PCI能降低ST段抬高型心肌梗死患者AKI发生率。

Aim To investigate the risk factors of acute kidney injury( AKI) in patients with acute myocardial infarction( AMI). Methods 728 patients with AMI were divided into two groups: AKI group and non AKI group.Clinical characteristics were compared in the two groups. The independent risk factors of AKI in patients with AMI were analyzed. The effect of emergency percutaneous coronary intervention( PCI) on AKI occurrence was assessed in patients with AMI. Results In 728 AMI patients,AKI was found in 152 patients( 20. 9%). Compared with non AKI group,the differences of the eleven indexes of AKI group were statistically significant( P < 0. 01),these indexes including: age,history of diabetes,mean arterial pressure,systolic blood pressure,heart rate,cardiac function Killip classification,left ventricular ejection fraction,base estimated glomerular filtration rate( e GFR),ST-segment elevation myocardial infarction,β-blocker and ACEI / ARB application. Multivariate Logistic regression analysis showed that age,history of diabetes,admission systolic blood pressure,degree of cardiac function,left ventricular ejection fraction,base e GFR,unused ACEI / ARB medication were independent risk factors of AKI occurrence in patients with AMI. In 378 cases of STsegment elevation myocardial infarction,256 patients underwent emergency PCI. Statistical analysis showed that the incidence of AKI was significantly higher in patients with non-PCI than that in patients with emergency PCI( 39. 3% vs19. 5%,P < 0. 01). Conclusions AKI is a common complication of AMI,which is related to many factors. Emergency PCI can reduce the incidence of AKI in patients with ST segment elevation myocardial infarction.