文章摘要
糖尿病合并急性心肌梗死患者PCI术后造影剂肾病的危险因素及SHI、HbA1c的预测价值研究
Risk Factors for Contrast-Induced Nephropathy and the Predictive Value of SHI and HbA1c in Patients With Diabetes Mellitus Combined With Acute Myocardial Infarction After PCI
投稿时间:2022-10-20  修订日期:2022-10-20
DOI:
中文关键词: 急性心肌梗死  糖尿病  经皮冠状动脉介入治疗  造影剂肾病  应激性高血糖指数  糖化血红蛋白
英文关键词: Acute myocardial infarction  Diabetes mellitus  Percutaneous coronary intervention  Contrast-induced nephropathy  Stress hyperglycemia index  Glycated hemoglobin
基金项目:安徽省教育厅高校自然科学研究重点项目(编号:KJ2020A0189)
作者单位邮编
施春丽 徽医科大学附属巢湖医院 238000
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中文摘要:
      目的 探讨糖尿病合并急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后造影剂肾病(CIN)的危险因素,并分析应激性高血糖指数(SHI)和糖化血红蛋白(HbA1c)对CIN的预测价值。方法 选取2019年1月~2022年1月我院收治的102例接受PCI治疗的糖尿病合并AMI患者,根据PCI术后是否发生CIN分为CIN组26例和非CIN组76例。收集患者基线资料和计算SHI,采用单因素和多因素Logistic回归分析糖尿病合并AMI患者PCI术后CIN的影响因素,受试者工作特征(ROC)曲线分析SHI、HbA1c对糖尿病合并AMI患者PCI术后CIN的预测价值。结果 单因素分析显示,CIN组年龄大于非CIN组,高血压比例、Killip分级≥Ⅱ级比例和心肌肌钙蛋白T、N末端B型利钠肽前体(NT-proBNP)、超敏C反应蛋白(hs-CRP)、血糖、HbA1c、血尿酸、血尿素氮、血肌酐、SHI高于非CIN组,淋巴细胞计数、白蛋白、估算肾小球滤过率(eGFR)低于非CIN组(P<0.05)。多因素Logistic回归分析显示,年龄增加、高血压、Killip分级≥Ⅱ级、NT-proBNP升高、白蛋白降低、hs-CRP升高、HbA1c升高、血肌酐升高、eGFR降低、SHI升高为糖尿病合并AMI患者PCI术后CIN的独立危险因素(均P<0.05)。ROC曲线分析显示,SHI、HbA1c联合预测糖尿病合并AMI患者PCI术后CIN的曲线下面积大于两者单独预测的曲线下面积。结论 年龄增加、高血压、Killip分级≥Ⅱ级、NT-proBNP、hs-CRP、HbA1c、血肌酐、SHI升高及白蛋白、eGFR降低为糖尿病合并AMI患者PCI术后CIN的独立危险因素,SHI联合HbA1c对糖尿病合并AMI患者PCI术后CIN的预测价值较高。
英文摘要:
      Objective To investigate the risk factors for contrast-induced nephropathy (CIN) in patients with diabetes mellitus combined with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI), and to analyze the predictive value of stress hyperglycemia index (SHI) and glycated hemoglobin (HbA1c) for CIN. Methods 102 patients with diabetes mellitus combined with AMI who underwent PCI who were admitted to our hospital from January 2019 to January 2022 were selected, and they were divided into 26 cases in the CIN group and 76 cases in the non-CIN group according to whether CIN occurred after PCI. Baseline data of patients were collected and SHI was calculated. Univariate and multivariate Logistic regression were used to analyze the influencing factors of CIN after PCI in diabetes mellitus patients combined with AMI. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of SHI and HbA1c for CIN in diabetes mellitus patients combined with AMI after PCI. Results Univariate analysis showed that CIN group was older than non-CIN group, the proportion of hypertension, Killip grade≥Ⅱ, cardiac troponin T, N-terminal proB-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), blood glucose, HbA1c, uric acid, urea nitrogen, creatinine and SHI were higher than those in the non-CIN group, the lymphocyte count, albumin and estimated glomerular filtration rate (eGFR) were lower than those in the non-CIN group (P<0.05). Multivariate Logistic regression analysis showed that increased age, hypertension, Killip grade≥Ⅱ, increased NT-proBNP, decreased albumin, increased hs-CRP, increased HbA1c, increased serum creatinine, decreased eGFR, and increased SHI were independent risk factors for CIN in patients with diabetes mellitus combined with AMI after PCI (all P<0.05). ROC curve analysis showed that the area under curve of SHI and HbA1c combined to predict CIN after PCI was greater than the area under curve of them alone. Conclusion Increase age, hypertension, Killip grade greater than or equal to Ⅱ, NT-proBNP, hs-CRP, HbA1c, serum creatinine, SHI and decrease albumin and eGFR are independent risk factors for CIN in patients with diabetes mellitus combined with AMI after PCI. SHI combined with HbA1c has a high predictive value for CIN in patients with diabetes mellitus combined with AMI after PCI.
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