中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2014年
10期
725-731
,共7页
孙妍蓓%刘必成%邹芸%潘家荣%陶源%杨敏
孫妍蓓%劉必成%鄒蕓%潘傢榮%陶源%楊敏
손연배%류필성%추예%반가영%도원%양민
心肌梗死%流行病学%患病率%急性肾损伤
心肌梗死%流行病學%患病率%急性腎損傷
심기경사%류행병학%환병솔%급성신손상
Myocardial infarction%Epidemiology%Prevalence%Acute kidney injury
目的 探讨急性心肌梗死(AMI)患者急性肾损伤(AKI)的危险因素.方法 回顾性分析2008年12月1日至2012年12月31日在苏州大学附属第三医院诊断急性心肌梗死患者(共计1 371例)的临床资料,根据KDIGO指南推荐标准定义AKI.根据是否发生AKI将患者分成AKI组和非AKI组;根据AKI发生的时机分为保守治疗AKI组及保守治疗非AKI组,冠脉造影术(coronary angiography,CAG)后AKI组及CAG术后非AKI组,及冠脉搭桥术(coronary artery bypass grafting,CABG)后AKI组及CABG术后非AKI组.AKI相关危险因素的分析采用单因素、多因素Logistic回归.结果 AMI后410例患者(29.9％)并发AKI,其中保守治疗、CAG后、CABG后AKI的患病率依次为34.8％ (228/656)、24.5％ (168/686)、57.7％ (30/52).住院期间共计死亡107例,病死率为7.8％;AKI患者的病死率较非AKI组显著增高(17.1％比3.9％,x2=68.0,P＜0.001).多因素Logistic回归分析结果示保守治疗AKI组,基线eGFR下降(OR=2.049,95％ CI:1.246～3.370)、空腹血糖(FBG)升高(OR=1.070,95％CI:1.018～1.124)、利尿剂(OR=1.867,95％CI:1.220～2.856)和心梗KillipⅣ级(OR=1.362,95％CI:1.059～3.170)是AKI患病的独立危险因素(均P＜ 0.05),入院时舒张压(DBP)增高(OR=0.986,95％CI:0.974～0.998)是AKI患病的保护性因素(P＜ 0.05);CAG术后组,基线eGFR下降(OR=2.371,95％CI:1.500 ～ 3.747)、空腹血糖升高(OR=1.009,95％CI:1.005～1.012)、利尿剂(OR=1.674,95％CI:1.042～2.690)、术中低血压(OR=2.276,95％CI:1.324 ～ 3.575)和急性感染(OR=1.678,95％CI:1.023 ～ 2.754)是AKI患病的独立危险因素(均P＜ 0.05);CABG术后组,基线eGFR下降(OR=2.246,95％CI:1.340～3.981)、空腹血糖升高(OR=1.059,95％CI:1.018～ 1.124)、利尿剂(OR=1.723,95％CI:1.122～2.650)和术后低心排血量综合征(OR=2.331,95％CI:1.277～3.286)是AKI患病的独立危险因素(均P＜ 0.05).结论 住院AMI患者AKI的发生率、病死率均较高.基础肾功能减退、空腹血糖升高及利尿剂的应用为AMI患者并发AKI的独立危险因素.
目的 探討急性心肌梗死(AMI)患者急性腎損傷(AKI)的危險因素.方法 迴顧性分析2008年12月1日至2012年12月31日在囌州大學附屬第三醫院診斷急性心肌梗死患者(共計1 371例)的臨床資料,根據KDIGO指南推薦標準定義AKI.根據是否髮生AKI將患者分成AKI組和非AKI組;根據AKI髮生的時機分為保守治療AKI組及保守治療非AKI組,冠脈造影術(coronary angiography,CAG)後AKI組及CAG術後非AKI組,及冠脈搭橋術(coronary artery bypass grafting,CABG)後AKI組及CABG術後非AKI組.AKI相關危險因素的分析採用單因素、多因素Logistic迴歸.結果 AMI後410例患者(29.9％)併髮AKI,其中保守治療、CAG後、CABG後AKI的患病率依次為34.8％ (228/656)、24.5％ (168/686)、57.7％ (30/52).住院期間共計死亡107例,病死率為7.8％;AKI患者的病死率較非AKI組顯著增高(17.1％比3.9％,x2=68.0,P＜0.001).多因素Logistic迴歸分析結果示保守治療AKI組,基線eGFR下降(OR=2.049,95％ CI:1.246～3.370)、空腹血糖(FBG)升高(OR=1.070,95％CI:1.018～1.124)、利尿劑(OR=1.867,95％CI:1.220～2.856)和心梗KillipⅣ級(OR=1.362,95％CI:1.059～3.170)是AKI患病的獨立危險因素(均P＜ 0.05),入院時舒張壓(DBP)增高(OR=0.986,95％CI:0.974～0.998)是AKI患病的保護性因素(P＜ 0.05);CAG術後組,基線eGFR下降(OR=2.371,95％CI:1.500 ～ 3.747)、空腹血糖升高(OR=1.009,95％CI:1.005～1.012)、利尿劑(OR=1.674,95％CI:1.042～2.690)、術中低血壓(OR=2.276,95％CI:1.324 ～ 3.575)和急性感染(OR=1.678,95％CI:1.023 ～ 2.754)是AKI患病的獨立危險因素(均P＜ 0.05);CABG術後組,基線eGFR下降(OR=2.246,95％CI:1.340～3.981)、空腹血糖升高(OR=1.059,95％CI:1.018～ 1.124)、利尿劑(OR=1.723,95％CI:1.122～2.650)和術後低心排血量綜閤徵(OR=2.331,95％CI:1.277～3.286)是AKI患病的獨立危險因素(均P＜ 0.05).結論 住院AMI患者AKI的髮生率、病死率均較高.基礎腎功能減退、空腹血糖升高及利尿劑的應用為AMI患者併髮AKI的獨立危險因素.
목적 탐토급성심기경사(AMI)환자급성신손상(AKI)적위험인소.방법 회고성분석2008년12월1일지2012년12월31일재소주대학부속제삼의원진단급성심기경사환자(공계1 371례)적림상자료,근거KDIGO지남추천표준정의AKI.근거시부발생AKI장환자분성AKI조화비AKI조;근거AKI발생적시궤분위보수치료AKI조급보수치료비AKI조,관맥조영술(coronary angiography,CAG)후AKI조급CAG술후비AKI조,급관맥탑교술(coronary artery bypass grafting,CABG)후AKI조급CABG술후비AKI조.AKI상관위험인소적분석채용단인소、다인소Logistic회귀.결과 AMI후410례환자(29.9％)병발AKI,기중보수치료、CAG후、CABG후AKI적환병솔의차위34.8％ (228/656)、24.5％ (168/686)、57.7％ (30/52).주원기간공계사망107례,병사솔위7.8％;AKI환자적병사솔교비AKI조현저증고(17.1％비3.9％,x2=68.0,P＜0.001).다인소Logistic회귀분석결과시보수치료AKI조,기선eGFR하강(OR=2.049,95％ CI:1.246～3.370)、공복혈당(FBG)승고(OR=1.070,95％CI:1.018～1.124)、이뇨제(OR=1.867,95％CI:1.220～2.856)화심경KillipⅣ급(OR=1.362,95％CI:1.059～3.170)시AKI환병적독립위험인소(균P＜ 0.05),입원시서장압(DBP)증고(OR=0.986,95％CI:0.974～0.998)시AKI환병적보호성인소(P＜ 0.05);CAG술후조,기선eGFR하강(OR=2.371,95％CI:1.500 ～ 3.747)、공복혈당승고(OR=1.009,95％CI:1.005～1.012)、이뇨제(OR=1.674,95％CI:1.042～2.690)、술중저혈압(OR=2.276,95％CI:1.324 ～ 3.575)화급성감염(OR=1.678,95％CI:1.023 ～ 2.754)시AKI환병적독립위험인소(균P＜ 0.05);CABG술후조,기선eGFR하강(OR=2.246,95％CI:1.340～3.981)、공복혈당승고(OR=1.059,95％CI:1.018～ 1.124)、이뇨제(OR=1.723,95％CI:1.122～2.650)화술후저심배혈량종합정(OR=2.331,95％CI:1.277～3.286)시AKI환병적독립위험인소(균P＜ 0.05).결론 주원AMI환자AKI적발생솔、병사솔균교고.기출신공능감퇴、공복혈당승고급이뇨제적응용위AMI환자병발AKI적독립위험인소.
Objective To investigate the risk factors of acute kidney injury (AKI) in patients after acute myocardial infarction (AMI).Methods A total of 1 371 adult patients diagnosed AMI in the First People's Hospital of Changzhou from January 2008 to December 2012 were analyzed retrospectively.AKI was defined according to the 2012 KDIGO AKI criteria.Based on the occurrence of AKI,the patients were divided into AKI group and non-AKI group.According to the AKI timing,the patients were divided into subgroups including conservative treatment groups,coronary angiography (CAG) groups and coronary artery bypass grafting (CABG) groups,respectively.Related risk factors of AKI were analyzed by univariate and multivariate logistic regression.Results Of the 1 371 patients,410(29.9％) developed AKI.Compared to the non-AKI group,in-hospital mortality increased significantly in the AKI group (17.1％ vs 3.9％,x2=68.0,P ＜ 0.001).Multifactor retrospective analysis showed that decreased baseline eGFR (OR=2.049,95％ CI:1.246-3.370),increased fasting plasma glucose(FPG) (OR=1.070,95％CI:1.018-1.124),diuretics (OR=1.867,95％CI:1.220-2.856) and Killip class 4 status (OR=1.362,95％ CI:1.059-3.170) were all independent risk factors of AKI,while increased DBP on admission was a protective factor (OR=0.986,95％ CI:0.974-0.998) for the conservative management group.Decreased baseline eGFR (OR=2.371,95％CI:1.500-3.747),increased FPG(OR=1.009,95％CI:1.005-1.012),diuretics (OR=1.674,95％CI:1.042-2.690),intraoperative hypotension (OR=2.276,95％ CI:1.324-3.575) and acute infection (OR=1.678,95％CI:1.023-2.754) were independent risk factors of AKI for the CAG group.Decreased baseline eGFR (OR=2.246,95％CI:1.340-3.981),increased FPG (OR=1.059,95％CI:1.018-1.124),diuretics (OR=1.723,95％CI:1.122-2.650),and low cardiac output syndrome after operation (OR=2.331,95％ CI:1.277-3.286) were independent risk factors of AKI for CABG group.Conclusions AKI is a common complication and associated with increased mortality after AMI.Decreased baseline renal function,increased FPG and diuretics were common independent risk factors of AKI after AMI.
