脂蛋白(a)对急性ST段抬高型心肌梗死患者行经皮冠状动脉介入术后发生对比剂肾病的影响

Association between lipoprotein(a) and contrast-induced nephropathy in patients with acute ST-segment elevation myocardial infarction and undergoing primary percutaneous coronary intervention

目的探讨不同血清脂蛋白(a)[Lp(a)]水平患者在急性ST段抬高型心肌梗死(STEMI)行经皮冠状动脉介入术(PCI)后发生对比剂肾病(CIN)的差异。方法连续入选潍坊市人民医院2015年11月至2017年10月因STEMI而行PCI的患者745例。根据术后是否发生CIN,分为CIN组(73例)和非CIN组(672例)。分析两组患者临床基线资料的差异。采用多因素Logistic回归分析血清Lp(a)水平与STEMI患者PCI后发生CIN的相关性。结果 CIN组Lp(a)水平高于非CIN组[(317.8±123.7)比(173.1±76.2)mg/L,P<0.01]。多因素Logistic回归分析显示,在校正年龄、糖尿病、估算的肾小球滤过率、同型半胱氨酸等因素后,Lp(a)水平升高是STEMI患者PCI后发生CIN的独立危险因素(OR=1.199,95%CI 1.150～1.251,P<0.01)。结论血清Lp(a)水平升高STEMI患者行PCI后易发生CIN。

Objective To explore the association between the level of serum lipoprotein(a)[Lp(a)]and the incidence of contrast-induced nephropathy(CIN)in patients with acute ST-segment elevation myocardial infarction(STEMI)and undergoing primary percutaneous coronary intervention(PCI).Methods From November 2015 to October 2017,745 STEMI patients who underwent primary PCI in WeiFang People’s Hospital were recruited consecutively.Patients were divided into CIN group(n=73)and non-CIN group(n=672).The baseline clinical data were compared between the two groups.Multivariable logistic regression analysis was performed to identify the independent risk factors for CIN.Results The level of serum Lp(a)in STEMI patients was significantly higher in patients developed CIN than in those did not((317.8±123.7)vs(173.1±76.2)mg/L,P<0.01)After adjusted for age,diabetes,creatinine clearance and homocysteine etc,multivariate Logistic regression analysis showed that an elevated Lp(a)level was an independent risk factor for CIN in STEMI patients after PCI(OR=1.199,95%CI 1.150-1.251,P<0.01).Conclusion Elevated serum Lp(a)level may be an independent risk factor for the occurrence of CIN in patients with STEMI after PCI.