Ran Peng, Yang Junqing, Yang Xuxi, Zhou Yingling, Tan Ning, He Yiting, Li Guang, Sun Shuo, Liu Yong, Xie Nianjin, Chen Jiyan
Department of Cardiology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangdong Cardiovascular Institute, Guangzhou 510080, China.
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Zhonghua Xin Xue Guan Bing Za Zhi. 2014 Jul;42(7):551-6.
To study the relationship between carbon dioxide combining power(CO₂-CP) and contrast-induced acute kidney injury (CI-AKI) in patients with ST segment elevation myocardial infarction and undergoing percutaneous coronary intervention.
We retrospectively analyzed 174 patients admitted to our hospital from March 2012 to August 2013 with ST segment elevation myocardial infarction and underwent emergency percutaneous coronary intervention. Patients were divided into three tertiles according to pre-operative CO₂-CP: T1 (CO₂-CP < 22.62 mmol/L), T2(CO₂-CP 22.62-24.30 mmol/L), T3(CO₂-CP > 24.30 mmol/L). Baseline clinical data, CI-AKI incidence, in-hospital mortality and dialysis rate were compared among groups. An increase in serum creatinine of >26.4 µmol/L and/or >50% from baseline within 48 hours after contrast exposure was defined as CI-AKI. Univariate logistic regression analysis was used to identify the risk factors of CI-AKI. The relationship between CO₂-CP and CI-AKI was assessed by multivariate logistic regression analysis. Receiver operating characteristic curve was used to identify the optimal cutoff of the CO₂-CP for predicting CI-AKI.
CI-AKI occurred in 25 (14.4%) patients, and lower CO₂-CP was related to higher incidence of CI-AKI (27.6% (16/58) in group T1, 5.3% (3/57) in group T2, 1.7 % (1/59) in group T3, P = 0.002) and higher in-hospital mortality (10.3% (6/58) vs. 0 and 1.7% (1/59), P = 0.010). Dialysis rate was similar among 3 groups (5.2% (3/58) vs. 0 and 1.7% (1/59), P = 0.168). The incidence of CI-AKI was significantly associated with CO₂-CP < 22.00 mmol/L in univariate analyses (OR = 6.767, 95% CI 2.731-16.768, P < 0.001). After adjusting for potential confounding risk factors, CO₂-CP < 22.00 mmol/L remained significantly associated with the incidence of CI-AKI (OR = 5.835, 95%CI 1.800-18.914, P = 0.003) in multivariate logistic regression. ROC analysis revealed that the optimal cutoff of CO₂-CP to predict CI-AKI was 22.00 mmol/L (sensitivity 64.0%, specificity 79.1%, AUC = 0.714).
Pre-percutaneous coronary intervention CO₂-CP in patients with ST segment elevation myocardial infarction undergoing percutaneous coronary intervention is related to CI-AKI. CO₂-CP < 22.00 mmol/L predicts higher risk of CI-AKI in this patient cohort.
研究ST段抬高型心肌梗死且接受经皮冠状动脉介入治疗患者的二氧化碳结合力（CO₂-CP）与对比剂诱导的急性肾损伤（CI-AKI）之间的关系。
回顾性分析2012年3月至2013年8月我院收治的174例ST段抬高型心肌梗死且接受急诊经皮冠状动脉介入治疗的患者。根据术前CO₂-CP将患者分为三个三分位数组：T1（CO₂-CP＜22.62 mmol/L）、T2（CO₂-CP 22.62 - 24.30 mmol/L）、T3（CO₂-CP＞24.30 mmol/L）。比较各组的基线临床资料、CI-AKI发生率、住院死亡率及透析率。对比剂暴露后48小时内血清肌酐较基线水平升高＞26.4 µmol/L和/或升高＞50%定义为CI-AKI。采用单因素逻辑回归分析确定CI-AKI的危险因素。通过多因素逻辑回归分析评估CO₂-CP与CI-AKI的关系。采用受试者工作特征曲线确定预测CI-AKI的CO₂-CP最佳截断值。
25例（14.4%）患者发生CI-AKI，较低的CO₂-CP与较高的CI-AKI发生率相关（T1组为27.6%（16/58），T2组为5.3%（3/57），T3组为1.7%（1/59），P = 0.002），且住院死亡率较高（分别为10.3%（6/58）、0和1.7%（1/59），P = 0.010）。三组的透析率相似（分别为5.2%（3/58）、0和1.7%（1/59），P = 0.168）。单因素分析显示CI-AKI发生率与CO₂-CP＜22.00 mmol/L显著相关（OR = 6.767，95%CI 2.731 - 16.768，P＜0.001）。在多因素逻辑回归中，校正潜在混杂危险因素后，CO₂-CP＜22.00 mmol/L仍与CI-AKI发生率显著相关（OR = 5.835，95%CI 1.800 - 18.914，P = 0.003）。ROC分析显示预测CI-AKI的CO₂-CP最佳截断值为22.00 mmol/L（敏感性64.0%，特异性79.1%，AUC = 0.714）。
接受经皮冠状动脉介入治疗的ST段抬高型心肌梗死患者，术前CO₂-CP与CI-AKI相关。在该患者队列中，CO₂-CP＜22.00 mmol/L预示着CI-AKI的较高风险。
