| 赵宇飞,张建明,刘 欢,付春生,朱华良,杨二丽.血清MPO水平与PCI治疗患者造影剂所致急性肾损伤及预后的关系及其预测价值分析[J].,2023,(17):3299-3303 |
| 血清MPO水平与PCI治疗患者造影剂所致急性肾损伤及预后的关系及其预测价值分析 |
| The Relationship between Serum MPO Level and Contrast-induced Acute Kidney Injury and Prognosis in Patients Undergoing PCI and Its Predictive Value |
| 投稿时间：2023-03-06 修订日期：2023-03-31 |
| DOI：10.13241/j.cnki.pmb.2023.17.019 |
| 中文关键词: 经皮冠状动脉介入术 造影剂所致急性肾损伤 MPO 预后 预测价值 |
| 英文关键词: Percutaneous coronary intervention Contrast-induced acute kidney injury MPO Prognosis Predictive value |
| 基金项目:安徽省教育厅高校科研项目（2022AH050771） |
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| 中文摘要: |
| 摘要 目的：探究血清髓过氧化物酶（MPO）水平与急诊经皮冠状动脉介入（PCI）治疗患者造影剂所致急性肾损伤（CI-AKI）及预后的关系及其预测价值。方法：选取2020年3月-2021年2月于安徽医科大学第二附属医院行急诊PCI术的381例急性心肌梗死患者，收集其临床资料并于术前12 h内检测其血清MPO水平；根据术后有无发生CI-AKI分为CI-AKI组（n=34）和非CI-AKI组（n=347）。多因素Logistic回归分析急诊PCI术后患者发生CI-AKI影响因素，受试者工作特征（ROC）曲线评估MPO预测CI-AKI的效能；根据最佳截断值将患者分为高MPO组和低MPO组，对患者随访12个月，采用Kaplan-Meier生存曲线分析高MPO组、低 MPO组的累积主要不良心血管事件（MACE）发生率。结果：CI-AKI组合并高血压、糖尿病、高血脂、吸烟史占比多于非CI-AKI组，MPO水平、肌酐水平、造影剂用量高于非CI-AKI组（P＜0.05）。经多因素Logistic回归分析显示，糖尿病、高MPO及肌酐水平为影响患者急诊PCI术后发生CI-AKI的危险因素（P＜0.05）。ROC曲线分析显示，术前血清MPO水平预测急诊PCI术后CI-AKI的曲线下面积（AUC）为0.726，最佳截断值为491.12 μg/L，灵敏度58.80%、特异度76.50%。术后1年患者发生MACE共95例，发生率为24.93%。Kaplan-Meier生存曲线显示，高MPO组MACE发生率27.37%高于低MPO组22.77%（P＜0.05）。结论：急诊PCI术后发生CI-AKI的患者血清MPO水平显著提升，与患者预后存在关联，是CI-AKI的危险因素，具有较高的特异度，是预测急诊PCI术后发生CI-AKI的有效辅助指标。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the relationship between serum myeloperoxidase (MPO) level and contrast-induced acute kidney injury (CI-AKI) and prognosis in patients undergoing emergency percutaneous coronary intervention (PCI) and its predictive value. Methods: 381 patients with acute myocardial infarction who underwent emergency PCI in The Second Affiliated Hospital of Anhui Medical University from March 2020 to February 2021 were selected. The clinical data were collected and the serum MPO level was detected within 12 hours before operation. According to the occurrence of CI-AKI after operation, they were divided into CI-AKI group (n=34) and non CI-AKI group (n=347). Multivariate Logistic regression was used to analyze the influencing factors of the incidence of CI-AKI in patients undergoing emergency PCI, and receiver operating characteristic (ROC) curve was used to evaluate the effectiveness of MPO in predicting CI-AKI. According to the best cutoff value, the patients were divided into high MPO group and low MPO group, and the patients were followed up for 12 months. The cumulative incidence of major adverse cardiovascular events (MACE) in high MPO group and low MPO group were analyzed by Kaplan-Meier survival curve. Results: The proportion of combined hypertension, diabetes mellitus, hyperlipidemia and smoking history proportion in CI-AKI group were higher than those in non CI-AKI group, and MPO level, creatinine level, contrast agent dosage were higher than those in non CI-AKI group (P<0.05). Multivariate Logistic regression analysis showed that diabetes mellitus, high MPO and creatinine level were the risk factors influencing the occurrence of CI-AKI after emergency PCI (P<0.05). ROC curve analysis showed that the area under the curve(AUC) of preoperative serum MPO level in predicting CI-AKI after emergency PCI was 0.726, and the optimal cut-off value was 491.12 μg/L, with a sensitivity of 58.80%, and specificity of 76.50%. A total of 95 cases of MACE occurred one year after operation, with an incidence of 24.93%. Kaplan-Meier survival curve showed that the incidence of MACE in high MPO group was 27.37% higher than that in low MPO group 22.77%(P<0.05). Conclusion: The serum MPO level of patients with CI-AKI after emergency PCI significantly increased, which is associated with the prognosis of patients, and it is a risk factor for CI-AKI, with high specificity, which can be an effective auxiliary indicator for predicting the occurrence of CI-AKI after emergency PCI. |
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