微量白蛋白尿在非糖尿病急性心肌梗死患者中的预后意义。

Prognostic significance of microalbuminuria in non-diabetic patients with acute myocardial infarction.

作者信息

Lekatsas Ioannis, Koulouris Spyridon, Triantafyllou Konstantinos, Chrisanthopoulou Georgia, Moutsatsou-Ladikou Paraskevi, Ioannidis Georgios, Thalassinos Nikolaos, Kalofoutis Anastasios, Anthopoulos Lambros

机构信息

1st Department of Cardiology, Evagelismos Hospital, Athens, Greece.

出版信息

Int J Cardiol. 2006 Jan 13;106(2):218-23. doi: 10.1016/j.ijcard.2005.02.004.

DOI:10.1016/j.ijcard.2005.02.004

PMID:16321695

Abstract

BACKGROUND

The aim of this study was to examine whether the presence of microalbuminuria (20-200 microg/min) can predict in-hospital morbidity and mortality in non-diabetic patients with acute myocardial infarction.

METHODS

Two hundred twenty-three (172 men and 51 women) non-diabetic patients with acute myocardial infarction were studied prospectively. The main outcome measures of the study were based on a comparison of in-hospital mortality and major non-fatal in-hospital events (pulmonary edema, post-infarction angina, infarct extension, mechanical complications, conduction disturbances and ventricular arrhythmias) between microalbuminuric and normoalbuminuric patients.

RESULTS

A significant proportion of patients (33.6%) had microalbuminuria. Seventy-six patients (34%) developed an in-hospital event (fatal or non-fatal). Six patients (2.7%) with acute myocardial infarction died in the hospital. Patients with microalbuminuria had a higher mortality rate in comparison with normoalbuminuric patients (6.6% vs. 0.68%, p = 0.01). For non-fatal events, the incidence of pulmonary edema and ventricular arrhythmias was significantly higher in patients with microalbuminuria (14.6% vs. 3.4%, p < 0.001 and 12% vs. 3.4%, p = 0.01, respectively). The combined end-point of the total number of fatal and non-fatal events was significantly higher in patients with microalbuminuria (57.3% vs. 22.3%, p < 0.001). In multiple logistic regression analysis, microalbuminuria (p < 0.001) and ejection fraction (p = 0.01) were independently related to the occurrence of major in-hospital events.

CONCLUSIONS

Microalbuminuria is a significant predictor of in-hospital morbidity and mortality in non-diabetic patients with acute myocardial infarction.

摘要

背景

本研究旨在探讨微量白蛋白尿（20 - 200微克/分钟）的存在是否能够预测非糖尿病急性心肌梗死患者的院内发病率和死亡率。

方法

对223例（172例男性和51例女性）非糖尿病急性心肌梗死患者进行前瞻性研究。本研究的主要观察指标基于微量白蛋白尿患者与正常白蛋白尿患者之间院内死亡率和主要非致命性院内事件（肺水肿、梗死后心绞痛、梗死扩展、机械并发症、传导障碍和室性心律失常）的比较。

结果

相当比例的患者（33.6%）存在微量白蛋白尿。76例患者（34%）发生了院内事件（致命或非致命）。6例（2.7%）急性心肌梗死患者在医院死亡。与正常白蛋白尿患者相比，微量白蛋白尿患者的死亡率更高（6.6%对0.68%，p = 0.01）。对于非致命事件，微量白蛋白尿患者肺水肿和室性心律失常的发生率显著更高（分别为14.6%对3.4%，p < 0.001和12%对3.4%，p = 0.01）。微量白蛋白尿患者致命和非致命事件总数的联合终点显著更高（57.3%对22.3%，p < 0.001）。在多因素逻辑回归分析中，微量白蛋白尿（p < 0.001）和射血分数（p = 0.01）与主要院内事件的发生独立相关。