The Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei 105, Taiwan.
J Crit Care. 2012 Oct;27(5):525.e1-7. doi: 10.1016/j.jcrc.2012.05.003. Epub 2012 Jul 2.
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.
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.
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.
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.
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.
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。
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。
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。
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）。
总之，较差的 TIMI 血流和较高的血浆胱抑素 C 可用于预测 AMI 后的 AKI。此外，IL-6 也可作为 AMI 后 30 天主要心血管事件的指标。应该进行更大规模的前瞻性和纵向研究，以探讨 AMI 后 AKI 预测因素之间的关系。
