2023 年第 8 期 第 18 卷

应激性高血糖比值对急性心肌梗死合并心源性休克患者院内出现急性肾损伤的预测价值

Predictive value of stress hyperglycemia ratio for acute renal injury in patients with acute myocardial infarction complicated with cardiogenic shock in hospital

作者：朱佳佳1郭雯1刘文娴1陈立颖1刘宝利2

英文作者：Zhu Jiajia1 Guo Wen1 Liu Wenxian1 Chen Liying1 Liu Baoli2

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中医医院肾内科，北京100010

英文单位：1Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Nephrology Beijing Chinese Medicine Hospital Capital Medical University Beijing 100010 China

关键词：急性心肌梗死；心源性休克；应激性高血糖比值；急性肾损伤

英文关键词：Acutemyocardialinfarction;Cardiogenicshock;Stresshyperglycemiaratio;Acutekidneyinjury

• 摘要：

• 目的 探讨应激性高血糖比值（SHR)对急性心肌梗死（AMI）合并心源性休克(CS)患者院内出现急性肾损伤（AKI）的预测价值。方法 连续性入选首都医科大学附属北京安贞医院2017年1月至2019年3月诊断为AMI-CS且发病24 h内入院患者共136例，根据院内是否发生AKI分为AKI组和非AKI组。收集患者临床资料，计算SHR。使用受试者工作特征（ROC）曲线分析SHR预测AMI-CS患者发生AKI的价值。采用单因素及多因素Logistic回归方法分析AMI-CS患者发生AKI的独立危险因素。结果 136例AMI-CS患者中院内发生AKI 39例（AKI组），AKI发生率为28.7%。非AKI组97例。AKI组院内死亡率高于非AKI组（P＜0.001）。SHR预测AMI-CS患者发生AKI的最佳截断值为1.08，敏感度为73.7%，特异度为57.4%，约登指数为0.311，曲线下面积为0.633（95%置信区间：0.523～0.743,P=0.017）。Logistic回归分析结果显示，年龄≥70岁、入院血肌酐＞106 μmol/L、高血压病、SHR＞1.08是AMI-CS患者发生AKI的独立危险因素（均P＜0.05）。结论 SHR＞1.08是AMI-CS患者发生AKI的独立危险因素。

• Objective To explore the predictive value of stress hyperglycemia ratio (SHR) for acute renal injury (AKI) in patients with acute myocardial infarction (AMI) complicated with cardiogenic shock (CS) in hospital. Methods  From January 2017 to March 2019, 136 patients with AMI-CS diagnosed and admitted within 24 h of onset were continuously selected in Beijing Anzhen Hospital, Capital Medical University. They were divided into AKI group and non-AKI group according to whether AKI occurred in hospital. The clinical data of patients were collected and SHR was calculated. The value of SHR in predicting AKI in patients with AMI-CS was analyzed by receiver operating characteristic (ROC) curve. Univariate and multivariate Logistic regression methods   were used to analyze the independent risk factors for AKI in patients with AMI-CS. Results Among 136 patients with AMI-CS, 39 cases had AKI in hospital (AKI group), with an incidence of 28.7%, and 97 cases in non-AKI group. The mortality rate in hospital in AKI group was higher than that in non-AKI group (P＜0.001). The best cutoff value for SHR to predict AKI in patients with AMI-CS was 1.08, with the sensitivity of 73.7%, the specificity of 57.4%, the Youden index of 0.311 and an area under the curve of 0.633 (95% confidence interval: 0.523-0.743, P=0.017). Logistic regression analysis showed that age≥70 years, blood creatinine＞106 μmol/L in hospital, hypertension history and SHR＞1.08 were independent risk factors for AKI in patients with AMI-CS (all P＜0.05). Conclusion Ss  HR>1.08 is an independent risk factor for AKI in patients with AMI-CS.