2023 年第 5 期 第 18 卷

应激性高血糖比值与急性心肌梗死患者发生急性肾损伤的关系

Relationship between stress hyperglycemia ratio and acute kidney injury in patients with acute myocardial infarction

作者：郭雯1朱佳佳1马涵英2刘文娴1

英文作者：Guo Wen1 Zhu Jiajia1 Ma Hanying2 Liu Wenxian1

单位：1首都医科大学附属北京安贞医院心内科，北京100029；2首都医科大学附属北京安贞医院全科医疗科，北京100029

英文单位：1Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of General Practice Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：急性心肌梗死；应激性高血糖比值；急性肾损伤

英文关键词：Acutemyocardialinfarction;Stresshyperglycemiaratio;Acutekidneyinjury

• 摘要：

• 目的 探讨应激性高血糖比值（SHR)与急性心肌梗死（AMI）患者发生急性肾损伤（AKI）的关系。方法连续性收集首都医科大学附属北京安贞医院2020年1月至2021年2月收治的AMI患者，根据院内是否发生AKI分为AKI组和非AKI组。比较2组SHR及其他临床资料。采用 Logistic 回归方法分析AMI患者发生AKI的危险因素。结果  本研究纳入856例AMI患者，其中院内发生AKI患者146例（AKI组），占17.1%，未发生AKI患者710例（非AKI组）。AKI组年龄、慢性肾脏疾病、陈旧性脑梗死、Killip分级≥3级比例，以及血尿素氮、血肌酐、入院即刻血糖、SHR、心肌肌钙蛋白、B型脑钠肽水平和呼吸机、利尿剂、正性肌力药物使用比例均高于非AKI组，白蛋白、估算肾小球滤过率、左心室射血分数（LVEF）、急诊经皮冠状动脉介入比例、对比剂总量均低于非AKI组（均P＜0.05）。AKI组住院时间、院内心源性休克发生率和病死率均高于非AKI组［8(5,14)d比6(5,9)d、8.2%（12/146）比0.8%（6/710）、24.0%（35/146）比9.0%（64/710）］，差异均有统计学意义（均P＜0.001）。多因素Logistic回归分析结果显示，SHR（比值比=5.35，95%置信区间：3.17～9.27，P＜0.001）、使用呼吸机、年龄以及慢性肾脏疾病均为AMI患者发生AKI的独立危险因素，LVEF为AMI患者发生AKI的保护性因素（均P＜0.05），而入院即刻血糖及空腹血糖均被排除。在糖尿病及非糖尿病AMI患者的亚组分析中，SHR均为发生AKI的独立危险因素（均P＜0.05），而入院即刻血糖及空腹血糖均被排除。结论   SHR是AMI患者院内发生AKI的独立危险因素。

• Objective  To explore the relationship between stress hyperglycemia ratio (SHR) and acute kidney injury (AKI) in patients with acute myocardial infarction (AMI). Methods From January 2020 to February 2021, the patients with AMI admitted to Beijing Anzhen Hospital, Capital Medical University were continuously collected, and they were divided into AKI group and non-AKI group according to whether AKI occurred in the hospital. SHR and other clinical data were compared between the two groups. Logistic regression method was used to analyze the risk factors of AKI in AMI patients. ResultsA total of 856 patients with AMI were included in this study, including 146 patients with AKI in the hospital (AKI group), accounting for 17.1%, and 710 patients without AKI (non-AKI group). The age, proportions of chronic kidney disease, old cerebral infarction, Killip grade≥3, the levels of blood urea nitrogen, serum creatinine, plasma glucose immediately after admission, SHR, cardiac troponin, brain natriuretic peptide, and the proportions of taking respirator, diuretic, positive inotropic drugs in AKI group were higher than those in non-AKI group, and the albumin, estimated glomerular filtration rate, left ventricular ejection fraction (LVEF), the proportion of emergency percutaneous coronary intervention, and total amount of contrast agent were lower than those in non-AKI group (all P＜0.05). The length of stay, incidence rate of hospital cardiogenic shock and fatality rate in AKI group were higher than those in non-AKI group ［8(5,14)d vs 6(5,9)d, 8.2%(12/146) vs 0.8%(6/710), 24.0%(35/146) vs 9.0%(64/710)］(all P＜0.001). Multivariate Logistic regression analysis showed that SHR (odds ratio=5.35, 95% confidence interval: 3.17-9.27, P＜0.001), ventilator use, age and chronic kidney disease were independent risk factors for AKI in AMI patients, and LVEF was a protective factor for AKI in AMI patients (all P＜0.05). The plasma glucose immediately after admission and fasting plasma glucose were excluded. In the subgroup analysis of diabetic and non-diabetic AMI patients, SHR was an independent risk factor for AKI, respectively (both P＜0.05), while the plasma glucose immediately after admission and fasting plasma glucose were excluded. Conclusions HR is an independent risk factor for AKI in AMI patients.