CAJ | 학술논문

目的：探讨急性ST段上抬型心肌梗死(ST-segment elevation myocardial infarction，STEMI)患者发生1型心肾综合征(cardio-renal syndrome Type 1，CRS1)的危险因素。方法：STEMI患者378例分为CRS1组(n=98)和非CRS1组(n=280)。比较两组患者的临床资料，分析STEMI患者发生CRS1的独立危险因素，观察急诊冠脉介入治疗(percutaneous coronary intervention，PCI)对STEMI患者发生CRS1的影响。结果：378例STEMI患者中发生CRS1共98例(25.9%)，两组间年龄、糖尿病史、入院平均动脉压、入院收缩压、入院心率、Killip分级、左室射血分数、血清肌酐基值、基础预估肾小球滤过率(evaluated glomerular ifltration rate，eGFR)、急诊PCI、β-受体阻滞剂和血管紧张素转化酶抑制剂/血管紧张素II受体拮抗剂(angiotensin converting enzyme inhibitors / angiotensin II receptor antagonist，ACEI/ARB)应用在内的十二项指标差异具有统计学意义(均P<0.05)，多因素logistic分析显示年龄、糖尿病史、入院收缩压降低、心功能Killip分级、左室射血分数降低、基础eGFR降低、未急诊PCI、未使用ACEI/ARB药物是STEMI患者发生CRS1的独立危险因素。256例患者接受急诊PCI，50例(19.5%)出现CRS1。CRS1组门-球时间及对比剂用量明显高于无CRS1患者(均P<0.05)，但术后“罪犯血管”血流恢复情况两组间比较差异无统计学意义(P>0.05)。结论：CRS1是STEMI常见的并发症，其发生与多种因素有关，及时的血运重建能降低STEMI患者的CRS1发生率。
목적：탐토급성ST단상태형심기경사(ST-segment elevation myocardial infarction，STEMI)환자발생1형심신종합정(cardio-renal syndrome Type 1，CRS1)적위험인소。방법：STEMI환자378례분위CRS1조(n=98)화비CRS1조(n=280)。비교량조환자적림상자료，분석STEMI환자발생CRS1적독립위험인소，관찰급진관맥개입치료(percutaneous coronary intervention，PCI)대STEMI환자발생CRS1적영향。결과：378례STEMI환자중발생CRS1공98례(25.9%)，량조간년령、당뇨병사、입원평균동맥압、입원수축압、입원심솔、Killip분급、좌실사혈분수、혈청기항기치、기출예고신소구려과솔(evaluated glomerular ifltration rate，eGFR)、급진PCI、β-수체조체제화혈관긴장소전화매억제제/혈관긴장소II수체길항제(angiotensin converting enzyme inhibitors / angiotensin II receptor antagonist，ACEI/ARB)응용재내적십이항지표차이구유통계학의의(균P<0.05)，다인소logistic분석현시년령、당뇨병사、입원수축압강저、심공능Killip분급、좌실사혈분수강저、기출eGFR강저、미급진PCI、미사용ACEI/ARB약물시STEMI환자발생CRS1적독립위험인소。256례환자접수급진PCI，50례(19.5%)출현CRS1。CRS1조문-구시간급대비제용량명현고우무CRS1환자(균P<0.05)，단술후“죄범혈관”혈류회복정황량조간비교차이무통계학의의(P>0.05)。결론：CRS1시STEMI상견적병발증，기발생여다충인소유관，급시적혈운중건능강저STEMI환자적CRS1발생솔。
Objective: To explore the risk factors for Type 1 cardio-renal syndrome (CRS1) atfer ST-segment elevation myocardial infarction (STEMI). Methods: A total of 378 patients with STEMI were divided into two groups: a CRS1 group (n=98) and a non-CRS1 group (n=280). Clinical characteristics in the 2 groups were compared, and independent risk factors for CRS1 after STEMI were analyzed, and the effect of emergency Results: In the 378 STEMI patients, CRS1 was found in 98 patients (25.9%). Between the 2 groups, there was significant difference in 12 parameters, including age, history of diabetes, admission mean arterial pressure, admission systolic blood pressure, admission heart rate, Killip classification, left ventricular ejection fraction, baseline serum creatinine, baseline evaluated glomerular ifltration rate (eGFR), emergency PCI, β-blockers and angiotensin converting enzyme inhibitor/angiotensin, receptor antagonist (ACEI/ARB) application (allP<0.05). Multivariate logistic regression showed that age, history of diabetes, admission systolic blood pressure, Killip classification, reduced left ventricular ejection fraction, reduced eGFR, emergency PCI non-undergo and ACEI/ARB non-use were independent risk factors for CRS1 atfer STEMI. In the 256 patients undergoing emergency PCI, 50 patients (19.5%) had CRS1. hTe door-ball time and the amount of contrast agent in the CRS1 group were signiifcantly higher than those in the non- CRS1 group (bothP<0.05), but there was no signiifcant difference in the blood lfow in the “culprit vessel”atfer the PCI (P>0.05). Conclusion: CRS1 is a common complication of STEMI, which is associated with many factors. Immediate revascularization can reduce the incidence of CRS1 in patients with ST-segment elevation myocardial infarction.