急诊PCI术前肾小球滤过率对急性ST段抬高型心肌梗死病人预后的影响
Effect of the glomerular filtration rate before emergency PCI on the prognosis of patients with ST-segment elevation myocardial infarction
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摘要: 目的：探讨急诊经皮冠状动脉介入术（PCI）肾小球滤过率（eGFR）对急性ST段抬高型心肌梗死（STEMI）病人预后的影响。方法：接受急诊PCI术前治疗的STEMI病人134例，根据术前eEFG水平分为低eGFR组（<60 mL·min-1·1.73 m-2）14例和高eGFR组（≥60 mL·min-1·1.73 m-2）120例，比较2组心肌缺血再灌注损伤相关指标和住院期间及术后1年内主要心血管事件（MACE）发生率。结果：低eGFR组病人入院时年龄、既往卒中发生率、Killip分级≥Ⅲ级病人比例和hs-CRP、BNP水平及Gensini评分均高于高eGFR组（P<0.05~P<0.01）。术后低eGFR组术后LVEF明显低于高eGFR组（P<0.01）。与高eGFR组相比，低eGFR组住院期间死亡、再梗和急性心衰发生率均明显较高（P<0.01）；而2组PCI术后1年内的MACE发生率差异均无统计学意义（P>0.05）。多因素logistic回归分析结果显示，Killip分级≥Ⅲ级、eGFR水平<60 mL·min-1·1.73 m-2是STEMI病人院内死亡的独立危险因素（P<0.05）。结论：低eGFR的STEMI病人院内MACE发生率高，其亦是STEMI病人院内死亡的独立危险因素，入院后应积极检测eGFR水平，根据肾功能情况调整用药，积极改善肾功能。Abstract: Objective: To investigate the effects of the glomerular filtration rate(eGRF) before emergency percutaneous coronary intervention(PCI) on the prognosis of patients with ST-segment elevation myocardial infarction(STEMI).Methods: One hundred and thirty-four STEMI patients treated with PCI were divided into the low eGFR group(14cases,eGFR<60 mL·min-1·1.73 m-2) and high eGFR group(120 cases,eGFR>60 mL·min-1·1.73 m-2) according to the preoperative level of eGFR.The MIRI and incidence rate of MACE between two groups were compared.Results: The age,previous incidence of stroke,ratio of patients with Killip ≥ Ⅲ grade,levels of hs-CRP and BNP,and gensini score in low eGFR group were higher than those in high eGFR group(P<0.05 to P<0.01).The LVEF level in low eGFR group was significantly lower than that in high eGFR group(P<0.01).Compared with the high eGFR group,the incidence rates of death,restenosis and acute heart failure during hospitalization were higher in low eGFR group(P<0.01),and the differences of the incidence rates of myocardial infarction,stroke,cardiogenic death and vascular reconstruction between two groups after 1 year of PCI were not statistically significant(P<0.05).Multiple logistic regression analysis results showed that the Killip ≥ Ⅲ grade and eGFR<60 mL·min-1·1.73 m-2 was the independent risk factor for in-hospital mortality in patients with STEMI.Conclusions: The incidence rate of in-hospital MACE in STEMI patients with low eGFR is high,and also the independent risk factor for in-hospital mortality in patients with STEMI.Monitoring the level of eGFR and adjusting medicine can actively improve kidney function of patients.
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