摘要
目的 探讨中性粒细胞绝对值(ANC)、尿肾损伤分子1(KMI-1)与急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后缺血再灌注急性肾损伤(AKI)的相关性.方法 纳入行PCI的114 例AMI患者为研究对象,根据患者PCI术后72h内是否发生AKI分为AKI组和非AKI组.比较两组一般资料、PCI后2h的ANC、尿KMI-1与其他实验室指标,分析ANC、尿KMI-1与AMI患者PCI后缺血再灌注AKI的关系.记录患者术后3 个月心血管不良事件,分析ANC、尿KMI-1水平与心血管不良事件发生的关系.结果 AKI组病变冠状动脉支数≥3支占比、ANC、C反应蛋白(CRP)、肌酐(Cr)、尿KMI-1水平均高于非AKI组,淋巴细胞绝对值(ALC)低于非AKI组,差异有统计学意义(Z=3.50,t分别=3.67、2.12、6.24、8.36、2.96,P均＜0.05).经logistic回归分析结果显示,ANC、Cr、尿KMI-1与AMI患者PCI后缺血再灌注AKI有关(OR分别=5.04、1.32、1.36,P均＜0.05);ANC、尿KMI-1单独及联合模型预测的曲线下面积(AUC)为0.74、0.91、0.93.随访3 个月发现,随着ANC、尿KMI-1升高,PCI后短期MACE发生率也随着升高(χ2 分别=13.77、9.36,P均＜0.05).结论 ANC、尿KMI-1与AMI患者行PCI后缺血再灌注AKI有关,同时可提示AMI患者行PCI后短期预后情况,其机制与炎症反应有关.
Abstract
Objective To investigate the correlation between absolute neutrophil count(ANC),urinary kidney injury molecule-1(KMI-1)and acute kidney injury(AKI)after ischemia-reperfusion after percutaneous coronary intervention(PCI)in acute myocardial infarction(AMI)patients.Methods Totally 114 AMI patients who underwent PCI were in-cluded as the study subjects,and they were divided into AKI group and non AKI group according to the occurrence of AKI within 72 hours after PCI.The general data,ANC,urinary KMI-1 and other laboratory indexes in 2h after PCI were compared between the two groups,and the relationships between ANC,urinary KMI-1 and ischemia-reperfusion AKI af-ter PCI in AMI patients were analyzed.Cardiovascular adverse events were recorded in 3 months after operation,and the relationships between ANC and urinary KMI-1 levels and cardiovascular adverse events were analyzed.Results The proportion of coronary artery branches≥3,ANC,C-reactive protein(CRP),and creatinine(Cr)level and urinary KMI-1 in the AKI group were higher than those in the non AKI group,and the absolute value of lymphocytes(ALC)was lower than that in the non AKI group,with statistically significant differences(Z=3.50,t=3.67,2.12,6.24,8.36,2.96,P＜0.05).Logistic regression analysis showed that ANC,Cr and urinary KMI-1 were related to ischemia-reperfusion AKI in AMI patients after PCI(OR=5.04,1.32,1.36,P＜0.05).The areas under the curve(AUC)of ANC,urinary KMI-1,combined detection were 0.74,0.91,0.93,respectively.After a 3-month follow-up,it was found that as the ANC and urinary KMI-1 increased,the short-term MACE incidence rate after PCI also increased(χ2=13.77,9.36,P＜0.05).Conclusion ANC and urinary KMI-1 are related to ischemia-reperfusion AKI in AMI patients after PCI,and can indicate the short-term prognosis of AMI patients after PCI.The mechanism is related to inflammatory response.
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