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目的:评估急性心肌梗死(AMI)患者肾功能恶化的发生率和预后价值。方法:入选了267例AMI患者,平均年龄67.4岁。AMI患者住院第1、2、3天各检测1次血浆肌酐(Cr)值,以后每3d检测1次,直至第15天或出院。以Cr值较入院升高≥44.2μmol/L判断肾功能恶化,计算其发生率,采用logistic回归分析筛选AMI患者住院期间死亡的危险因素。结果:267例中32例(12.0%)住院期间发生了肾功能恶化。发生肾功能恶化的AMI患者年龄较大,陈旧性心肌梗死患病率高,Killip分级较高,入院时尿素氮值、Cr值较高,GFR估算值较低。用logistic回归分析筛选出肾功能不全、肾功能恶化是AMI患者住院期间死亡的危险因素。发生肾功能恶化的AMI患者死亡风险增加至4.287倍(95%CI为2.117～11.282,P<0.01)。结论:AMI患者住院期间肾功能恶化发生率为12.0%,是其预后的预测因子。
Objective: To evaluate the incidence and prognosis of renal dysfunction in patients with acute myocardial infarction (AMI). Methods: A total of 267 AMI patients were selected, with an average age of 67.4 years. Plasma creatinine (Cr) was measured in patients with AMI on days 1, 2 and 3, and once every 3 days until the 15th day or discharged. The Cr value was higher than that of admissions ≥ 44.2μmol / L to judge the worsening of renal function. The incidence of death was calculated by logistic regression analysis. RESULTS: Thirty-two (12.0%) of 267 patients experienced worsening renal function during hospitalization. AMI patients with deteriorating renal function are older, with a higher prevalence of old myocardial infarction, higher Killip classification, higher urea nitrogen values, higher Cr values, and lower GFR estimates at admission. Logistic regression analysis screened renal insufficiency, renal dysfunction is a risk factor for AMI death during hospitalization. The risk of death in AMI patients with worsening renal function increased to 4.287 (95% CI 2.117 to 11.282, P <0.01). Conclusion: The incidence of worsening of renal function in hospitalized patients with AMI was 12.0%, which was a predictor of prognosis.