急性心肌梗死病人急诊PCI后发生对比剂肾病的危险因素分析

目的:探讨急性心肌梗死病人急诊经皮冠状动脉介入治疗（PCI）后发生对比剂肾病（CIN）的危险因素。方法:选取110例行急诊PCI治疗的急性心肌梗死病人，按是否出现CIN，将其分为CIN组和非CIN组，比较2组病人对比剂剂量（CMV）、基础疾病、术前用药情况、一般资料等，分析CIN的相关危险因素。结果:2组病人在肾脏替代治疗、中风、输血、心绞痛、死亡等事件上差异均无统计学意义（P>0.05）。比较住院期间2组病人不良事件发现，CIN组机械通气、急性心力衰竭、主动脉球囊反搏辅助和心率失常均高于非CIN组（P<0.05~P<0.01）。CIN组在血糖、超敏C反应蛋白（hs-CRP）、肌酸激酶峰值、贫血、血肌酐（Scr）、CMV等方面均明显高于非CIN组（P<0.01），在肾小球滤过率（eGFR）、血红蛋白、左心室射血分数（LVEF）低于非CIN组（P<0.05~P<0.01）。多因素分析显示，CMV、肾功能不全、Scr、LVEF、eGFR、糖尿病、贫血、hs-CRP以及CMV/eGFR比值均为CIN发生的危险因素（P<0.05~P<0.01）。结论:对急性心肌梗死病人进行急诊PCI治疗时，要严格控制病人的CMV、肾功能不全、Scr、LVEF、eGFR、糖尿病、贫血、hs-CRP以及CMV/eGFR比值，以减少CIN的发生。

Risk factor analysis of contrast-induced nephropathy in AMI patients treated with emergence PCI

Objective:To investigate the risk factors of contrast-induced nephropathy(CIN) in acute myocardial infarction(AMI) patients treated with emergence percutaneous coronary intervention(PCI).Methods:One hundred and ten AMI patients treated with emergency PCI were divided into the CIN group and non-CIN group.The drug dosage,basic disease,preoperative medication and general data between two groups were compared,and the related risk factors of CIN were analyzed.Results:The differences of the renal replacement therapy,stroke,blood transfusion,angina and death between two groups were not statistically significant(P>0.05).During hospitalization,the mechanical ventilation,acute heart failure,aortic balloon pacing assistance,and arrhythmias in CIN group were higher than those in non-CIN group(P<0.05 to P<0.01).The blood glucose,hypersensitive C-reactive protein(hs-CRP),creatinine kinase peak value,anemia,serum creatinine(Scr) and contrast dose (CMV) in CIN group were significantly higher than those in non-CIN group(P<0.05 to P<0.01).The glomerular filtration rate(eGFR),hemoglobin,left ventricular ejection fraction (LVEF) in CIN group were lower than those in non-CIN group(P<0.05 to P<0.01).Multivariate analysis results showed that the CMV,renal insufficiency,Scr,LVEF,eGRF,diabetes,anemia,hs-CRP and ratio of CMV/eGFR were the risk factors of the occurrence of CIN(P<0.05 to P<0.01).Conclusions:The CMV,renal insufficiency,Scr,LVEF,eGRF,diabetes,anemia,hs-CRP and ratio of CMV/eGFR in AMI patients treated with emergence PCI should be strictly controlled to decrease the occurrence of CIN.