急性心肌损伤患者急性肾损伤的早期预测。

Early prediction of acute kidney injury in patients with acute myocardial injury.

机构信息

The Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei 105, Taiwan.

出版信息

J Crit Care. 2012 Oct;27(5):525.e1-7. doi: 10.1016/j.jcrc.2012.05.003. Epub 2012 Jul 2.

DOI:10.1016/j.jcrc.2012.05.003

PMID:22762928

Abstract

INTRODUCTION

Previous studies have revealed that acute myocardial infarction (AMI) with acute kidney injury (AKI), about 17%, is strongly related to long-term mortality and heart failure. The dynamic changes in renal function during AMI are strongly related to long-term mortality and heart failure.

OBJECTIVES

Our study used clinical parameters and AKI biomarkers including neutrophil gelatinase-associated lipocalin, interleukin (IL)-6, IL-18, and cystatin C to evaluate prognostic relevance of AKI in the setting of AMI.

METHODS

This prospective study was conducted from November 2009 to January 2011 and enrolled sequential 96 patients with catheter-proven AMI; it was approved by the institutional review board of Chang Gung Memorial Hospital, Taiwan (institutional review board no. 99-0140B) and conformed to the tenets of the Declaration of Helsinki. The definition of AKI is the elevation of serum creatinine of more than 0.3 mg/dL within 48 hours.

RESULTS

Our results show that the incidence of AKI after AMI is 17.7% (17 patients). The following could be statistically related to AKI after AMI: age (P = .012), cardiac functions (Killip stage and echocardiogram; P = .003 each), Thrombolysis in Myocardial Infarction (TIMI) flow grade (P < .001), stenting (P < .001), neutrophil gelatinase-associated lipocalin (P = .005), IL-6 (P = .01), IL-18 (P = .002), and cystatin C (P = .002) in serum. The TIMI flow grade and serum cystatin C were shown to be important predictors by using multivariate analysis. Both TIMI flow lower than grade 2 and serum cystatin C of more than 1364 mg/L could be used to predict AKI (both overall correctness, 0.78). Moreover, IL-6 in serum is also associated with the major cardiovascular events after AMI (P = .02), as demonstrated in our study.

CONCLUSION

In conclusion, the worse TIMI flow and high plasma cystatin C can be used to predict AKI after AMI. Moreover, IL-6 can also be used as a 30-day major cardiovascular event indicator after AMI. A larger prospective and longitudinal study should follow the relationship between AKI predictors after AMI.

摘要

简介

先前的研究表明，约 17%的伴有急性肾损伤（AKI）的急性心肌梗死（AMI）与长期死亡率和心力衰竭密切相关。AMI 期间肾功能的动态变化与长期死亡率和心力衰竭密切相关。

目的

本研究使用临床参数和 AKI 生物标志物，包括中性粒细胞明胶酶相关脂质运载蛋白、白细胞介素（IL）-6、IL-18 和胱抑素 C，来评估 AMI 中 AKI 的预后相关性。

方法

这是一项前瞻性研究，于 2009 年 11 月至 2011 年 1 月进行，纳入了 96 例经导管证实的 AMI 患者；该研究得到了台湾长庚纪念医院机构审查委员会的批准（机构审查委员会编号 99-0140B），并符合《赫尔辛基宣言》的原则。AKI 的定义是 48 小时内血清肌酐升高超过 0.3mg/dL。

结果

我们的结果显示，AMI 后 AKI 的发生率为 17.7%（17 例）。以下因素与 AMI 后 AKI 具有统计学相关性：年龄（P=.012）、心功能（Killip 分期和超声心动图；P=.003 各因素）、心肌梗死溶栓治疗（TIMI）血流分级（P<.001）、支架置入术（P<.001）、中性粒细胞明胶酶相关脂质运载蛋白（P=.005）、IL-6（P=.01）、IL-18（P=.002）和血清胱抑素 C（P=.002）。多变量分析显示，TIMI 血流分级和血清胱抑素 C 是重要的预测因素。TIMI 血流分级低于 2 级和血清胱抑素 C 超过 1364mg/L 均可用于预测 AKI（两者总体正确性均为 0.78）。此外，我们的研究还表明，血清中 IL-6 也与 AMI 后主要心血管事件相关（P=.02）。