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目的探评价急性ST段抬高型心肌梗死(STEMI)患者入院即刻肾功能状态及对院内预后的影响。方法多中心、前瞻性队列研究。入选自2005年12月至2007年1月,在发病后24小时内至北京市19家医院就诊的STEMI患者718例。入院即刻测定血清肌酐,根据改良的简化MDRD公式计算估计的肾小球滤过率(eGFR)。分为肾功能正常组(eGFR≥90ml/(min·1.73m2)、轻度肾功能不全组(60ml/(min·1.73m2≤eGFR<90ml/(min·1.73m2)和中度肾功能不全组(eGFR<60ml/(min·1.73m2),比较三组的临床特点和院内死亡和心血管事件发生情况,采用多元Logistic回归分析影响STEMI患者院内死亡和主要心血管事件的危险因素。结果 718例患者中共有280例(39.0%)已经存在不同程度的肾功能不全(eGFR<90ml/min),其中61例(8.5%)为中度以上肾功能不全(eGFR<60ml/min)。与肾功能正常组相比,轻度肾功能不全组和中度肾功能不全组患者年龄偏大(57±12)岁vs(66±13)岁vs(72±13)岁,P<0.01),女性比例多(16.9%vs39.2%vs48.3%,P<0.01),既往有高血压病(47.7%vs59.8%vs70.5%,P<0.01),心力衰竭(0%vs2.7%vs6.6%,P<0.01),脑卒中或一过性脑缺血(TIA)病史(8.9%vs10.6%vs19.3%,P<0.05),入院时心功能Killip≥II级(34.7%vs37.0%vs65.5%,P<0.01)较多。院内病死率(1.4%vs5.9%vs22.9%,P<0.01)和心血管事件(18.0%vs27.4%vs63.9%,P<0.01)显著增高。多因素Logistic回归分析显示入院即刻肾功能不全是STEMI患者发生院内死亡和心血管事件的独立危险因素(OR值分别为3.870;95%CI:1.767-8.474,P<0.01和1.712;95%CI:1.217-2.408,P<0.01)。结论 STEMI患者中肾功能不全发生率较高,院内死亡及心血管事件的发生率随肾功能恶化而增加,肾功能不全是院内死亡和心血管事件的独立危险因素。
Objective To evaluate the immediate status of renal function and prognosis in patients with acute ST-elevation myocardial infarction (STEMI). Methods Multicenter, prospective cohort study. Selected from December 2005 to January 2007, within 24 hours after onset to 19 hospitals in Beijing, STEMI treatment of 718 patients. Serum creatinine was measured immediately at admission and the estimated glomerular filtration rate (eGFR) was calculated based on the modified simplified MDRD formula. The patients with normal renal function (eGFR≥90ml / (min · 1.73m2), mild renal insufficiency (60ml / (min · 1.73m2≤eGFR <90ml / (min · 1.73m2)) and moderate renal insufficiency (eGFR <60ml / (min · 1.73m2)) .Multivariate logistic regression analysis was used to analyze the risk factors of nocturnal death and major cardiovascular events in STEMI patients.Results 718 cases A total of 280 patients (39.0%) had varying degrees of renal dysfunction (eGFR <90ml / min), of which 61 (8.5%) had moderate to severe renal insufficiency (eGFR <60ml / min) Compared with the normal group, the age of the patients with mild renal insufficiency and moderate renal insufficiency (57 ± 12) years old vs (66 ± 13) years old (72 ± 13 years old, P <0.01) (16.9% vs39.2% vs48.3%, P <0.01), previous history of hypertension (47.7% vs59.8% vs70.5%, P <0.01), heart failure (0% vs2.7% vs6 .6%, P <0.01), the history of stroke or transient ischemic attack (TIA) (8.9% vs10.6% vs19.3%, P <0.05) vs37.0% vs65.5%, P <0.01) .In-hospital mortality (1.4% vs5.9% vs22.9%, P <0.01) and cardiovascular events (18.0% vs27.4% vs63 .9%, P <0.01) .Multivariate Logistic regression analysis showed that immediate admission renal insufficiency was an independent risk factor for in-hospital mortality and cardiovascular events in patients with STEMI (OR = 3.870; 95% CI: 1.767-8.474 , P <0.01 and 1.712; 95% CI: 1.217-2.408, P <0.01) .Conclusion The incidence of renal insufficiency in patients with STEMI is high. The incidence of nosocomial death and cardiovascular events increases with the worsening of renal function. Incomplete is an independent risk factor for nosocomial death and cardiovascular events.