CAJ | 학술논문

目的观察急性心肌梗死(AMI)患者经皮冠状动脉介入(PCI)术前心肌肌钙蛋白Ⅰ(cTnI)水平与术后对比剂肾病(CIN)风险的关系. 方法回顾性收集2011年1月至2013年6月在我院心脏中心行急诊PCI治疗的cTnI升高(＞0.4 μg/L)的235例老年AMI患者的临床资料,按照术前cTnI水平分为cTnI＜4.0 μg/L组133例、cTnI≥4.0 μgL)组102例.记录患者基线情况、术前及术后1、3、7d血尿素(BUN)、肌酐(Scr)、β2-微球蛋白(β2-MG),并计算肾小球滤过率(eGFR),术后记录对比剂用量、冠状动脉病变特点,观察术后1年内临床事件发生情况,采用多因素Logistic回归分析CIN的影响因素. 结果 cTnI≥4.0 μg/L患者CIN发生率为22.55％(23/102)高于cTnI＜4.0 μg/L组10.53％(14/133),差异有统计学意义(x2=21.56,P＜0.01);两组患者在急诊PCI术后第1天均出现eGFR下降和β2-MG升高,且cTnI≥4.0μg/L组较cTnI＜4.0μg/L组患者的eGFR下降及β2-MG升高幅度更明显(P＜0.05),术后第7天时均恢复到术前水平;cTnI≥4.0 μg/L组3支血管病变例数多于cTnI＜4.0 μg/L组(x2=16.60,P＜0.01),置入支架数量少于cTnI＜4.0 μg/L组(x2 =6.41,P＜0.05);cTnI≥4.0 μg/L组发生再发心绞痛、急性心力衰竭及死亡高于cTnI＜4.0μg/L组(P＜0.05);多因素Logistic回归分析结果显示,术前高cTnI(OR=2.160)、糖尿病(OR=3.056)、肾功能不全(OR=1.632)、对比剂用量(OR=3.665)、高龄(OR=3.521)是术后发生CIN的危险因素. 结论术前cTnI水平与急诊PCI术后CIN发生率相关,术前高cTnI水平是CIN的临床危险因素.
목적 관찰급성심기경사(AMI)환자경피관상동맥개입(PCI)술전심기기개단백Ⅰ(cTnI)수평여술후대비제신병(CIN)풍험적관계. 방법 회고성수집2011년1월지2013년6월재아원심장중심행급진PCI치료적cTnI승고(＞0.4 μg/L)적235례노년AMI환자적림상자료,안조술전cTnI수평분위cTnI＜4.0 μg/L조133례、cTnI≥4.0 μgL)조102례.기록환자기선정황、술전급술후1、3、7d혈뇨소(BUN)、기항(Scr)、β2-미구단백(β2-MG),병계산신소구려과솔(eGFR),술후기록대비제용량、관상동맥병변특점,관찰술후1년내림상사건발생정황,채용다인소Logistic회귀분석CIN적영향인소. 결과 cTnI≥4.0 μg/L환자CIN발생솔위22.55％(23/102)고우cTnI＜4.0 μg/L조10.53％(14/133),차이유통계학의의(x2=21.56,P＜0.01);량조환자재급진PCI술후제1천균출현eGFR하강화β2-MG승고,차cTnI≥4.0μg/L조교cTnI＜4.0μg/L조환자적eGFR하강급β2-MG승고폭도경명현(P＜0.05),술후제7천시균회복도술전수평;cTnI≥4.0 μg/L조3지혈관병변례수다우cTnI＜4.0 μg/L조(x2=16.60,P＜0.01),치입지가수량소우cTnI＜4.0 μg/L조(x2 =6.41,P＜0.05);cTnI≥4.0 μg/L조발생재발심교통、급성심력쇠갈급사망고우cTnI＜4.0μg/L조(P＜0.05);다인소Logistic회귀분석결과현시,술전고cTnI(OR=2.160)、당뇨병(OR=3.056)、신공능불전(OR=1.632)、대비제용량(OR=3.665)、고령(OR=3.521)시술후발생CIN적위험인소. 결론 술전cTnI수평여급진PCI술후CIN발생솔상관,술전고cTnI수평시CIN적림상위험인소.
Objective To analyze the association between the cardiac troponin Ⅰ (cTnI) level and the risk of contrast-induced nephropathy (CIN) in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI).Methods Clinical data of 235 elderly patients with AMI who underwent PCI from January 2011 to June 2013 in our hospital were analyzed retrospectively.Patients were divided into two groups based on preprocedural cTnI levels: the moderate cTnI level group (0.4 μg/L)＜cTnI＜4 μg/L, n=133) and the high cTnI level group (cTnI ≥4 μgL, n=102).The following data were recorded: the baseline measurements, blood urea nitrogen (BUN), serum creatinine (Scr), (2-microglobulin (β2-MG) levels before PCI and 1 d, 3 d,and 7 d after PCI, estimated glomerular filtration rate (eGFR), the contrast volume and coronary pathological features after PCI, and occurrence of clinical events within 1 year.Risk factors for CIN were determined by multivariate logistic regression analysis.Results The incidence of CIN was significantly higher in the high cTnI level group than in the moderate cTnI level group [22.55％ (23/ 102) vs.10.53％ (14/133), x2 =21.56, P＜0.01].eGFR declined and the β2-MG level increased more significantly in the high cTnI level group than in the moderate cTnI level group (P＜0.05), and went back to baseline levels 7 days after PCI.Patients with three-vessel lesions were more likely to be in the high cTnI level group than in the moderate cTnI level group (x2 =16.60, P＜0.01), and the number of stents was lower in the high cTnI level group than in the moderate cTnI level group (x2 =6.41, P＜0.05).The rates of angina pectoris, acute heart failure and mortality were higher in the high cTnI level group than in the moderate cTnI level group (P＜ 0.05).Multivariate logistic regressive analysis showed that high levels of preprocedural cTnI (OR=2.160), diabetes (OR=3.056), renal insufficiency (OR=1.632), contrast volume (OR=3.665), and old age (OR=3.521)were risk factors for the incidence of CIN.Conclusions The preprocedural cTnI level is associated with the incidence of CIN in patients with AMI undergoing PCI, and high preprocedural cTnI levels are a clinical risk factor for CIN.