肾功能不全对急性心肌梗死患者治疗方案及预后的影响

目的观察肾功能不全对急性心肌梗死(AMI)患者治疗方案及预后的影响。方法入选2011年6月~2012年5月因AMI住院治疗患者523例,根据改良的MDRD方程计算估测的肾小球滤过率(eGFR),根据eGFR水平将患者分为肾功能正常及轻度肾功能不全组(A组,eGFR≥60ml/min.1.73m2),中重度肾功能不全组(B组,eGFR60ml/min.1.73m2)。比较两组患者临床特点、治疗方案和预后的差异。结果 A组患者占71.7%(375/523),B组患者占28.3%(148/523)。与A组患者相比,B组患者年龄偏大、女性较多(P0.01),合并高血压、糖尿病、脑卒中及贫血比例较高(P0.05)。B组患者接受抗凝、β受体阻滞剂、他汀类、ACEI/ARB类药物以及PCI治疗的比例显著低于A组患者(P0.01)。B组患者院内死亡率显著高于A组(P0.01)。影响院内死亡的多因素回归分析显示:除年龄、女性、合并高血压、糖尿病、PCI治疗外,eGFR下降与院内死亡率增加独立相关(OR=6.362,95%CI:2.154~16.892,P0.01)。结论急性心肌梗死合并中重度肾功能不全患者住院期间接受急性心肌梗死指南推荐治疗的比例低于肾功能正常及轻度异常组;急性心肌梗死合并中重度肾功能不全患者院内死亡率增高;中重度肾功能不全是急性心肌梗死患者院内死亡的独立危险因素。

Influences of renal insufficiency on therapeutic schedule and prognosis in patients with acute myocardial ;infarction

Objective To observe the influences of renal insufficiency on therapeutic schedule and prognosis in patients with acute myocardial infarction （AMI）. Methods The patients （n=523） were chosen from Jun. 2011 to May 2012, and then divided into group A （with normal renal function or mild renal insufficiency, eGFR≥60mL/min.1.73m2） and group B （with medium or severe renal insufficiency, eGFR〈60mL/min.1.73m2） according to eGFR level after calculating and estimating eGFR by using modified MDRD equation. The clinical characteristics, therapeutic schedule and prognosis were compared between 2 groups. Results The percentage of patients with complicating renal insufficiency was 71.7%（375/523） in group A and 28.3%（148/523） in group B. Compared with group A, patients were older and more were female, and proportion of complicating hypertension, diabetes, stroke and anemia was higher in group B （P〈0.01）. The percentage of patients accepted treatment of anticoagulation,β-receptor blocker, statins and ACEI/ARB drugs was significantly lower in group B than that in group A （P〈0.01）. The in-hospital mortality was significantly higher in group B than that in group A （P〈0.01）. The multi-factor regression analysis on in-hospital mortality showed that eGFR decrease was independently correlated to the increase of in-hospital mortality （OR=6.362, 95%CI：2.154-16.892, P〈0.01） besides of age, female, complicating hypertension, complicating diabetes and PCI treatment. Conclusion The proportion of patients accepted AMI guideline-recommended treatment was lower in group B than that in group A during hospitalization, and in-hospital mortality was higher in group A. Medium or severe renal insufficiency is an independent risk factor of in-hospital mortality in AMI patients.