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ST段抬高型心肌梗死患者心外膜脂肪组织与对比剂诱导的急性肾损伤之间的关联

Association Between Epicardial Adipose Tissue and Contrast-Induced Acute Kidney Injury in Patients with ST-Segment Elevation Myocardial Infarction.

作者信息

Zang Baohe, Hu Weiwei, Chao Yali, Wang Dengji

机构信息

Department of Intensive Care Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, People's Republic of China.

出版信息

Ther Clin Risk Manag. 2025 Apr 24;21:543-552. doi: 10.2147/TCRM.S518586. eCollection 2025.

Abstract

BACKGROUND

Epicardial adipose tissue (EAT) affects the kidneys by secreting various bioactive molecules. Contrast-induced acute kidney injury (CI-AKI) is a common complication after percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients. The relationship between EAT and CI-AKI remains unclear. This study aims to explore the relationship between EAT and the incidence of CI-AKI after PCI in STEMI patients.

METHODS

Patients diagnosed with STEMI were continuously included, all patients underwent PCI within 12 hours of onset. EAT volume was measured and obtained by chest CT. Logistic regression analysis was used to analyze possible risk factors for CI-AKI. Restricted cubic splines (RCS) were utilized to explore the dose-response relationship involving EAT and CI-AKI.

RESULTS

The incidence of CI-AKI was 8.9% (57/638). Compared with the Non-CI-AKI group, the EAT volume was significantly higher (<0.005). After adjusting for confounding factors, multivariate regression analysis showed FBG, NT-proBNP, LVEF, and EAT volume were the independent predictors for CI-AKI. RCS analysis indicated a linear dose-response relationship between EAT volume and CI-AKI. The integration of EAT volume could significantly improve ability of the model for CI-AKI (NRI 0.4071, 95% CI 0.231 ~ 0.583, < 0.001; IDI 0.1356, 95% CI 0.091 ~ 0.180, < 0.001).

CONCLUSION

Higher EAT volume was an independent risk factor for CI-AKI in STEMI patients. Integration of EAT volume could significantly improve the risk model for CI-AKI.

摘要

背景

心外膜脂肪组织(EAT)通过分泌多种生物活性分子影响肾脏。造影剂诱导的急性肾损伤(CI-AKI)是ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后常见的并发症。EAT与CI-AKI之间的关系尚不清楚。本研究旨在探讨STEMI患者PCI后EAT与CI-AKI发生率之间的关系。

方法

连续纳入诊断为STEMI的患者,所有患者在发病12小时内接受PCI。通过胸部CT测量并获取EAT体积。采用逻辑回归分析来分析CI-AKI的可能危险因素。利用限制性立方样条(RCS)来探讨EAT与CI-AKI之间的剂量反应关系。

结果

CI-AKI的发生率为8.9%(57/638)。与非CI-AKI组相比,EAT体积显著更高(<0.005)。在调整混杂因素后,多因素回归分析显示空腹血糖(FBG)、N末端脑钠肽前体(NT-proBNP)、左心室射血分数(LVEF)和EAT体积是CI-AKI的独立预测因素。RCS分析表明EAT体积与CI-AKI之间存在线性剂量反应关系。EAT体积的纳入可显著提高CI-AKI模型的预测能力(净重新分类指数[NRI] 0.4071,95%可信区间[CI] 0.2310.583,<0.001;综合判别改善指数[IDI] 0.1356,95%CI 0.0910.180,<0.001)。

结论

更高的EAT体积是STEMI患者发生CI-AKI的独立危险因素。EAT体积的纳入可显著改善CI-AKI的风险模型。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f5b1/12036593/be8c4f64bdd4/TCRM-21-543-g0001.jpg

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