急性ST段抬高型心肌梗死合并急性肾损伤的危险因素及其对预后的影响

目的：探讨急性ST段抬高型心肌梗死(STEMI)患者并发急性肾损伤(AKI)的危险因素及其对预后影响。方法选择我院2009年7月至2014年6月急性STEMI住院患者302例，根据是否发生AKI将患者分成AKI组和非AKI组。分析AKI发生的相关危险因素，观察住院期间主要不良心血管事件(充血性心力衰竭、恶性心律失常、心源性休克)发生率及死亡率。随访观察出院后1年全因死亡率。结果 STEMI患者并发AKI 75例，发病率为24.83%。多因素Logistic回归分析结果显示，左心室射血分数(LVEF)降低(OR=0.013，95%CI：0.000~0.327)、KillipⅣ级(OR=20.050，95%CI：6.520~61.654)、利尿剂(OR=3.102,95%CI：1.250~7.697)是AKI发生的独立危险因素；与非AKI组患者比较，AKI组患者住院期间主要不良心血管事件发生率及住院死亡率(5.28%vs 13.33%)显著升高，两组间比较差异均有统计学意义(P<0.05)。两组患者随访1年的生存曲线结果显示，AKI组患者全因死亡率明显高于非AKI组，两组间比较差异有统计学意义(P=0.003)。结论 LVEF降低、KillipⅣ级及利尿剂应用是STEMI患者并发AKI的独立危险因素；STEMI患者并发AKI增加住院不良心血管事件发生率及死亡率，降低患者1年生存率。

Study on risk factors and outcome of acute kidney injury complicating acute ST-segment elevation myocardial infarction

Objective To analyze the risk factors of acute kidney injury (AKI) in patients with acute ST-seg-ment elevation myocardial infarction (STEMI) and its effect on the prognosis of the patients. Methods A total of 302 STEMI patients in our hospital from Jul. 2009 to Jun. 2014 were included in the study. The patients were divided into AKI group and non-AKI group according to whether the patients were complicated with AKI. Risk factors of AKI, inci-dence of in-hospital major adverse cardiac events (heart failure, malignant arrhythmia and cardiogenic shock) and all-cause death were analyzed. The 1-year all-cause mortality after hospital discharge were investigated. Results AKI occurred in 75 (24.83%) STEMI patients during hospital stay. Analysis showed that decreased left ventricular ejection fraction (LVEF) (OR=0.013, 95% CI: 0.000~0.327), Killip class 4 (OR=20.050, 95% CI: 6.520~61.654) and diuretics (OR=3.102, 95%CI:1.250~7.697) were the independent risk factors of AKI. Patients with AKI had higher incidence of in-hospital major adverse cardiac events and all-cause death (5.28%vs 13.33%) than those without (P<0.05). AKI was strongly related to 1-year all-cause mortality after STEMI (P=0.003). Conclusion Decreased LVEF, Killip class 4 and diuretics are the independent risk factors of AKI after STEMI. Patients with AKI have higher incidence of in-hospital ma-jor adverse cardiac events and all-cause death, and higher 1-year all-cause mortality after STEMI.