ST段抬高型心肌梗死患者肌酐清除率的变化及临床意义

目的探讨肌酐清除率（Ccr）对ST段抬高型心肌梗死（STEMI）患者急性期并发症发生的预测意义，并进一步探讨多种临床变量对Ccr的影响。方法154例STEMI住院病例分为Ccr正常组（Ccr≥70ml／min）和Ccr降低组（Ccr〈70ml／min），比较两组患者在STEMI发生7d内各种并发症的发生率及病死率；进一步用多因素logistic回归分析统计多种因素对Ccr的影响。结果Ccr降低组患者在STEMI发生7d内并发症的发生率较Ccr正常组高（P〈0．05）；多因素logistic回归分析显示年龄〉75岁及多支冠脉病变是Ccr降低的独立危险因素，它们的比值比分别是4．848和4．002，95％可信区间分别为1．644-14．297和2．310～6．934，P值分别为0．0042和0．0001。结论STEMI患者早期肌酐清除率的下降预示并发症发生率、病死率高；多支冠脉病变、年龄〉75岁可影响STEMI患者急性期肌酐清除率。

Clinical analysis the change of endogenous creatinine clearance rate in the acute stage of patients with ST-segment elevation acute coronary syndromes

Objective To investigate the acute stage complications prediction significance of endogenous creatinine clearance rate （Ccr） in patients with ST-segment elevation myocardial infarction （STEMI）. And then to investigate the effects of some clinical changes on Ccr. Methods Record the clinical characterizes in 154 patients with STEMI within 7 days, then analysis the ratio of acute stage complications in Ccr≥ 70 ml/min group and Ccr〈 70 ml/min group. And analysis the effects of some factors on Ccr with Multivariate logistic regression analysis. Results There are a higher incidence of STEMI acute stage complications（within 7 days） in the group of patients with Ccr〈70 ml/min （P〈0.05）. Multivariate logistic regression analysis indicated that age〉75 year （odds ratio 4.848,95%CI 1.644 to 14.297,P=0.0042） and more vessels coronary disease （odds ratio 4.002,95%CI 2.310 to 6.934,P=0.0001 ） are the independent impact factors of the debase of Ccr. Conclusion Those findings demonstrate that the patients with Ccr 〈70 ml/min in STEMI acute stage will have a higher incidence of complications. More vessels coronary disease and age〉75 year can affect the Ccr of patients with STEMI in evidence.