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目的:探讨急性心肌梗死(AMI)非手术相关性急性肾损伤(AKI)的危险因素。方法:回顾性分析2008-12-01~2012-12-31在苏州大学附属第三医院诊断AMI后未行手术治疗发生AKI的患者及对照组人群资料共计656例,根据KDIGO指南推荐的标准定义AKI。结果:AMI后非手术(包括冠脉造影术、冠脉搭桥术)治疗后发生的AKI共计228例(34.8%),其病死率显著高于对照组(P<0.001)。多因素Logistic回归分析结果 :基线e GFR下降(OR=2.049,95%CI 1.246~3.370)、空腹血糖(FBG)升高(OR=1.070,95%CI 1.018~1.124)、利尿剂(OR=1.867,95%CI 1.220~2.856)和心肌梗死KillipⅣ级(OR=1.362,95%CI 1.059~3.170)是AKI患病的独立危险因素(P<0.05),入院时舒张压(DBP)增高(OR=0.986,95%CI 0.974~0.998)是AKI患病的保护性因素(P<0.05)。结论:住院AMI非手术治疗患者发生AKI的患病率、病死率较高。基础肾功能减退、空腹血糖增加、心功能下降及利尿剂为该人群患病的独立危险因素,基础舒张压水平升高为保护性因素。
Objective: To investigate the risk factors of non-operative acute kidney injury (AKI) in acute myocardial infarction (AMI). Methods: A retrospective analysis was performed on 656 patients with AKI who did not undergo surgical treatment after AMI was diagnosed in the Third Affiliated Hospital of Soochow University between December 2008 and December 2012. According to the recommended standard of KDIGO guidelines AKI. Results: A total of 228 patients (34.8%) had AKI after non-operation (including coronary angiography and coronary artery bypass grafting) after AMI. The mortality was significantly higher than that of the control group (P <0.001). Multivariate logistic regression analysis showed that baseline eGFR decreased (OR = 2.049,95% CI 1.246-3.370), fasting blood glucose (FBG) increased (OR = 1.070,95% CI 1.018-1.124) , 95% CI 1.220 ~ 2.856) and KillipⅣ grade of myocardial infarction (OR = 1.362,95% CI 1.059 ~ 3.170) were independent risk factors for AKI (P 0. 05) and increased diastolic blood pressure (DBP) 0.986, 95% CI 0.974 ~ 0.998) were the protective factors of AKI (P <0.05). Conclusion: The prevalence of AKI in non-surgical hospitalized patients with AMI is higher, and the mortality rate is higher. Basic renal dysfunction, increased fasting blood glucose, decreased cardiac function and diuretics as an independent risk factor for the population, basal diastolic blood pressure level as a protective factor.