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中华肾病研究电子杂志

中华肾病研究电子杂志 ›› 2021, Vol. 10 ›› Issue (03) : 133 -137. doi: 10.3877/cma.j.issn.2095-3216.2021.03.003

论著

慢性肾脏病患者经皮冠脉介入术后急性肾损伤预后及影响因素分析
贾丽芳1,†(), 周培一1, 白文英1   
  1. 1. 102600　北京市大兴区人民医院肾内科
  • 收稿日期:2021-04-19 出版日期:2021-06-28
  • 通信作者: 贾丽芳

Analysis of clinical prognosis and affecting factors for CKD patients with acute kidney injury after percutaneous coronary intervention

Lifang Jia1,†(), Peiyi Zhou1, Wenying Bai1   

  1. 1. Department of Nephrology, Beijing Daxing District People′s Hospital, Beijing 102600, China
  • Received:2021-04-19 Published:2021-06-28
  • Corresponding author: Lifang Jia
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贾丽芳, 周培一, 白文英. 慢性肾脏病患者经皮冠脉介入术后急性肾损伤预后及影响因素分析[J]. 中华肾病研究电子杂志, 2021, 10(03): 133-137.

Lifang Jia, Peiyi Zhou, Wenying Bai. Analysis of clinical prognosis and affecting factors for CKD patients with acute kidney injury after percutaneous coronary intervention[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2021, 10(03): 133-137.

目的

了解慢性肾脏病(CKD)患者经皮冠脉介入术(PCI)后发生急性肾损伤(AKI)的临床预后及其影响因素。

方法

回顾2016年1月至2020年8月北京市大兴区人民医院CKD患者PCI术后发生AKI患者的临床资料，对其预后情况及影响因素进行分析；使用Logistic回归方法分析影响肾功能恢复的危险因素。

结果

共纳入PCI术后发生AKI的CKD患者119例，好转出院102例(85.71%)，死亡/放弃治疗出院17例(13.79%)。肾功能恢复51例(42.86%)，未恢复68例(57.14%)。恢复组与未恢复组在术前血肌酐、尿蛋白、术前eGFR分期、AKI分期、Killip分级等指标方面存在统计学差异(P<0.05)。多因素Logistic回归分析显示尿蛋白阳性、术前CKD分期>3b期、AKI分期≥2期、Killip分级≥Ⅱ级是影响PCI术后AKI恢复的独立危险因素。

结论

PCI术后发生AKI的CKD患者肾脏预后差，肾功能恢复受多种因素影响。

关键词: 慢性肾脏病, 经皮冠脉介入术, 急性肾损伤, 预后
Objective

To investigate the clinical prognosis and affecting factors for acute kidney injury(AKI)after percutaneous coronary intervention(PCI)in patients with chronic kidney disease(CKD).

Methods

A retrospective study was made on the clinical data of CKD patients with AKI after PCI from January 2016 to August 2020 in Beijing Daxing District People′s Hospital. The clinical prognosis and affecting factors were analyzed. The logistic regression method was used to analyze the risk factors in the renal function recovery.

Results

A total of 119 patients were enrolled, of whom 102 (85.71%) were discharged after improvement from hospital, and 17 (13.79%) died or had treatment abandonment. Among the 119 patients, 51 cases (42.86%) recovered from AKI while 68 cases (57.14%) failed. There were statistically significant differences between the recovered group and the unrecovered group in preoperative serum creatinine, urine protein, preoperative eGFR stage, AKI stage, and Killip classification (P<0.05). Multivariate logistic regression analysis showed that the independent risk factors for the recovery of the renal function included positive urine protein, preoperative CKD stage>3b, AKI stage≥2, and Killip classification ≥Ⅱ.

Conclusion

The renal prognosis of AKI after PCI in patients with CKD was poor, and the recovery of the renal function could be affected by many factors.

Key words: Chronic kidney disease, Percutaneous coronary intervention, Acute kidney injury, Prognosis
表1 恢复组和未恢复组临床资料比较
指标 恢复组(n＝51) 未恢复组(n＝68) t/Z/χ2值 P值
男性(例) 40 46 1.691 0.193
年龄(岁) 68(56，77) 69(60，78) -0.333 0.739
吸烟(例) 31 49 1.681 0.195
饮酒(例) 25 29 0.477 0.490
高血压(例) 42 55 0.042 0.838
糖尿病(例) 27 40 0.410 0.522
HbAlc (%) 6.5(6.0，8.7) 7.1(6.1，8.6) -0.908 0.364
白蛋白(g/L) 36.94±3.90 36.34±5.91 0.674 0.502
TC(mmol/L) 4.28(3.42，5.34) 4.16(3.11，4.97) 0.940 0.347
HDL-C(mmol/L) 2.76(2.22，3.69) 2.79(1.73，3.70) -0.499 0.617
TG(mmol /L) 1.57(0.84，2.26) 1.35(0.91，2.23) -0.634 0.526
血尿酸(μmol/L) 450.90±114.43 496.34±148.87 -1.814 0.070
血红蛋白(g/L) 125.45±23.77 123.62±23.13 0.423 0.673
尿蛋白阳性(例) 19a 51 17.142 <0.001
术前Scr(μmol/L) 124.21±23.49a 147.19±53.72 -2.854 0.005
术前eGFR[ml/(min·1.73 m2)] 50.20±14.81a 41.87±12.39 3.340 0.001
术后Scr峰值(μmol/L) 171.56±36.87a 235.68±47.53 -3.064 0.003
AKI分期≥2期(例) 8a 29 9.887 0.002
出院时/随访Scr(μmol/L) 130.63±28.62a 218.71±51.34 -3.367 0.001
ST段抬高性心肌梗死(例) 15 26 1.005 0.316
冠脉3支病变(例) 34 50 0.661 0.416
MAP(mmHg) 97(92，102) 93(86，111) -1.276 0.202
Killip分级≥Ⅱ级(例) 28a 51 5.275 0.022
CCU住院天数(d) 4.0(1.0，6.5) 4.0(2.0，7.8) -1.240 0.215
住院天数(d) 10.0(8.5，13.0) 10.0(6.0，15.5) -0.086 0.931
表2 影响肾功能恢复因素的Logistic回归分析
影响因素 回归系数 OR 95%CI P值
尿蛋白阳性(1/0) 1.760 5.812 2.397～14.092 <0.001
术前CKD3b期以上(1/0) 0.908 2.480 1.036～5.938 0.004
AKI分期≥2期(1/0) 1.407 4.083 1.442～11.556 0.008
Killip分级≥Ⅱ级(1/0) 0.937 2.552 1.031～6.320 0.003
常量 -2.149 0.117 - 0.021
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