摘要
目的 探讨基础肾功能不全是否与STEMI伴有室壁瘤的患者的病死率相关,血清胱氨酸蛋白酶抑制剂C （cystatin C Cy-C）水平和Cy-C计算的eGFR来评估急性心肌梗死伴有室壁瘤患者的基础肾功能损害的总体预后的价值.方法 回顾性临床病例对照研究,连续收集201 1年1月到2012年12月间355例来自两家医院的急性心肌梗死患者,其中183例为单纯急性心肌梗死,172例为急性心肌梗死伴有室壁瘤患者.通过检测入院时血清（creatinine Cr）和Cy-C水平,并分别计算相应的肾小球滤过率,来评估心功能.通过x2检验分析两组住院期间病死率的差别,并通过多因素回归分析,探讨基线肾功能损害和病死率的相关性.结果 在全体患者中,住院期间总病死率是14.0％,在急性心肌梗死伴室壁瘤组为18.6％,单纯心梗组为9.8％（P＜0.01）.多因素回归分析发现基线肾功能损害,包括以Cr为基础的计算的eGFR＜ 60 mL/（min·1.73 m2）,或以Cy-C为基础计算的eGFR＜ 60 mL/（min·1.73 m2）都和这些患者住院期间病死率密切相关（OR0.13,95％ CI0.02～0.7,P=0.02; OR0.01,95％ CI0.003～0.05,P＜0.01）.而Cy-C为基础计算的eGFR来评估急性心肌梗死患者的基线肾功能,以及总体的预后价值均较敏感.结论 基线肾功能损害在急性心肌梗死患者,特别是伴有室壁瘤患者中具有重要的预后价值.通过Cy-C计算的eGFR在评估急性心肌梗死,特别是伴有室壁瘤的患者中,具有更敏感的预后价值.
Objective To determine the renal function compromised in patients after ST-segment elevation myocardial infarction （STEMI） with left ventricular aneurysms （LVA） by measurement of serum cystatin C （Cy-C） concentrations and Cy-C-based eGFR.Methods A total of 355 patients admitted from January 2011 to December 2012 could be categorized into group A （STEMI without LVA,n =183） and group B （STEMI with LVA,n =172） confirmed by echocardiography in 24 hour after admission.Of them,273 patients were treated with primary percutaneous coronary intervention （PCI） after admission and included in the analysis.Cy-C-based estimated glomerular filtration rate （eGFR） and creatinine （Cr）-based eGFR were calculated for evaluating cardiac function in tern to assess the magnitude of compromised renal function.The correlation between magnitude of compromised renal function and in-hospital mortality was analyzed.Distributions of categorical variables were compared using the chi-square test.Continuous variables were compared by one-way ANOVA with the Bonferroni test.Results The in-hospital mortality rate of whole patient cohort was 14.0％.Mortality in the group B was 18.6％ and in the group A was 9.8％ （P ＜ 0.01）.With multivariable regression analysis,the compromised renal function was found when the Cr-based eGFR was ＜60 mL/ （min · 1.73 m2） or Cy-C-based eGFR was ＜ 60 mL/min/1.73m2 which were independently associated with in-hospital mortality （OR 0.13,95％ CI 0.02-0.7,P =0.02 ; OR 0.01,95％CI 0.003-0.05,P ＜ 0.01）.Compared with the acute myocardium infarction （AMI） patients with chronic kidney disease （CKD） stage 2,the Cy-C based eGFR was greater in the AMI patients with LVA group （P ＜ 0.05）,and compared with AMI with CKD stages 3 or CKD 3-5,this difference was also significant （P ＜ 0.01）.Conclusions Renal dysfunction was an independent predictor of in-hospital mortality in patients with STEMI,especially in patients with LVA.Cy-C and Cy-C based eGFR were more sensitive to judge renal dysfunction in STEMI patients with LVA.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2014年第2期191-195,共5页
Chinese Journal of Emergency Medicine
基金
浙江省科技厅项目（2012C37104）
国家自然科学基金（30900612）
