急性心肌梗死患者行急诊经皮冠状动脉介入治疗后造影剂肾病的影响因素及预后

目的 探讨急性心肌梗死患者行急诊经皮冠状动脉介入治疗(PCI)后造影剂肾病(CIN)的影响因素及对预后的影响.方法 选择2012年1月至2016年12月在西安市第一医院心内科行急诊PCI的急性ST段抬高心肌梗死患者320例,检测术前及术后48 h、72 h的血清肌酐,比较CIN组与非CIN组患者的临床资料及不良预后事件.结果 320例心肌梗死患者共发生CIN 62例(19.38%);多因素Logistic回归分析显示,入院时左心室射血分数(LVEF)及内生肌酐清除率(Ccr)、糖尿病肾病、心源性休克及造影剂用量是发生CIN的独立危险因素(P<0.05);CIN组不良事件总发生率为59.68%,明显高于非CIN组的10.08%,差异有统计学意义(P<0.05).结论 CIN是急性心肌梗死患者行急诊PCI者的常见并发症,会增加住院期间不良事件的发生率,应针对危险因素积极预防.

Determinants of contrast-induced nephropathy in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention and its prognosis

Objective To probe the determinants of contrast-induced nephropathy (CIN) in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI) and its prognosis. Methods A total of 320 patients of acute ST-segment elevation MI undergoing primary PCI from Jan. 2012 to Dec. 2016 in our hospital were selected. Serum creatinine (Scr) concentrations of patients before and 48 h, 72 h after PCI were determined, and clinical data and adverse prognosis events between CIN group and non-CIN group were com-pared. Results Sixty-two patients (19.38%) developed CIN in 320 AMI patients. Multi-factor logistic regression showed that LVEF on admission, creatinine clearance (Ccr) on admission, diabetic nephropathy, cardiac shock and dos-age of contrast were independent determinants of CIN (P<0.05). The total incidence of adverse events in CIN group was 59.68%, which was significantly higher than 10.08% of non-CIN group (P<0.05). Conclusion CIN is the common complication of AMI patients undergoing PCI, and its adverse events in hospitalization will increase. Positive precaution should be taken aiming at its risky factors.