摘要
目的研究急性心肌梗死(AMI)患者发生急性肾损害(AKI)的危险因素,创建预警评分系统。方法连续收集首都医科大学附属北京安贞医院肾内科2010年1月至2011年6月AMI患者1429例,根据患者是否伴有AKI分为2组,进行单因素比较及多元Logistic回归分析,进而创建预警评分系统,并进行验证。结果共入选1429例AMI患者,AKI发病率为14.7%。AKI的预警评分如下:高血压病史、未使用β受体阻滞剂、广泛前壁心肌梗死、eGFR从90 mL/(min.1.73 m2)起每下降10 mL/(min.1.73 m2)评1分;发病至入院时间≥6 h评2分;Killip分级≥3级、住院期间发生心源性休克评3分。依据约登指数,预测AKI的最佳评分分界点为3.5分,与<3.5分的患者比较,≥3.5分患者的AKI发生率的增加差异有统计学意义(5.0%对23.4%,P<0.01)。经过验证该预警评分系统具有较好的判别能力及校准能力。结论本研究创建了一个AMI患者发生AKI的预警评分系统,分数越高AKI发生率越高,可能有助于临床医师早期识别高危患者并实施预防性干预。
Objectlve To derive and validate a prediction score for acute kidney injury （AKI） in patients with acute myo- cardial infarction （AMI）. Methods The medical data of hospitalized patients with AMI from January,2010 to July,2011 in Beijing Anzhen Hospital were reviewed. All patients were divided into AKI group and non-AKI group. The univariate comparison and multivariate logistic regression analysis were performed to obtain the AKI risk factors and its OR values, and then to establish the prediction score. Results The total cohort consisted of 1429 patients with AMI, of whom AKI occurred in 210 （14. 7% ） patients. The prediction score of AKI was as follows：l point was assigned to hypertension history, non-use of 13-blocker, extensive anterior myocardial infarction, or eGFR reduction every 10 mL/（ min·1.73 m2） from 90 mL/ （min· 1.73 m2） ;2 points were assigned to the time from AMI attack to hospitalization I〉 6 h;and 3 points were assigned to Killip Classification 〉t Class 3 during admission, or cardiac shock in hospital period. A risk score of 3.5 points was deter- mined as the optimal cut-off for prediction of AKI. Patients with i〉3.5 points could be considered at high risks for develop- ment of AKI （23.4% vs. 5.0% in those with 3.5 points,P 〈0. 001 ）. Both the derived and validated datasets showed ade- quate discrimination （area under ROC curve 0. 769 and 0. 704, respectively） and calibration （Hosmer-Lemeshow statistic test,P = 0. 525 and 0. 130, respectively）. Conclusion A clinical prediction scoring system is developed for AK1 in patients with AMI. It may effectively predict AKI and help clinicians to make preventive intervention for high-risk patients.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2013年第5期377-380,I0001,共5页
Chinese Journal of Practical Internal Medicine
基金
首都特色临床医学应用发展项目(D101100050010017)
首都卫生发展科研专项(首发2011-2006-07)
关键词
急性心肌梗死
急性肾损伤
预警评分
acute myocardial infarction
acute kidney injury
risk factors
prediction score
