脂蛋白(a)对急性ST段抬高型心肌梗死患者行经皮冠状动脉介入术后发生对比剂肾病的影响
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摘要
目的探讨不同血清脂蛋白(a)[Lp(a)]水平患者在急性ST段抬高型心肌梗死(STEMI)行经皮冠状动脉介入术(PCI)后发生对比剂肾病(CIN)的差异。方法连续入选潍坊市人民医院2015年11月至2017年10月因STEMI而行PCI的患者745例。根据术后是否发生CIN,分为CIN组(73例)和非CIN组(672例)。分析两组患者临床基线资料的差异。采用多因素Logistic回归分析血清Lp(a)水平与STEMI患者PCI后发生CIN的相关性。结果 CIN组Lp(a)水平高于非CIN组[(317.8±123.7)比(173.1±76.2)mg/L,P<0.01]。多因素Logistic回归分析显示,在校正年龄、糖尿病、估算的肾小球滤过率、同型半胱氨酸等因素后,Lp(a)水平升高是STEMI患者PCI后发生CIN的独立危险因素(OR=1.199,95%CI 1.150～1.251,P<0.01)。结论血清Lp(a)水平升高STEMI患者行PCI后易发生CIN。
Objective To explore the association between the level of serum lipoprotein(a)[Lp(a)] and the incidence of contrast-induced nephropathy(CIN) in patients with acute ST-segment elevation myocardial infarction(STEMI) and undergoing primary percutaneous coronary intervention(PCI). Methods From November 2015 to October 2017, 745 STEMI patients who underwent primary PCI in WeiFang People's Hospital were recruited consecutively. Patients were divided into CIN group(n=73) and non-CIN group(n=672). The baseline clinical data were compared between the two groups. Multivariable logistic regression analysis was performed to identify the independent risk factors for CIN. Results The level of serum Lp(a) in STEMI patients was significantly higher in patients developed CIN than in those did not [(317.8±123.7) vs(173.1±76.2)mg/L, P<0.01]. After adjusted for age, diabetes, creatinine clearance and homocysteine etc, multivariate Logistic regression analysis showed that an elevated Lp(a) level was an independent risk factor for CIN in STEMI patients after PCI(OR=1.199,95% CI 1.150-1.251,P<0.01). Conclusion Elevated serum Lp(a) level may be an independent risk factor for the occurrence of CIN in patients with STEMI after PCI.
Objective To explore the association between the level of serum lipoprotein(a)[Lp(a)] and the incidence of contrast-induced nephropathy(CIN) in patients with acute ST-segment elevation myocardial infarction(STEMI) and undergoing primary percutaneous coronary intervention(PCI). Methods From November 2015 to October 2017, 745 STEMI patients who underwent primary PCI in WeiFang People's Hospital were recruited consecutively. Patients were divided into CIN group(n=73) and non-CIN group(n=672). The baseline clinical data were compared between the two groups. Multivariable logistic regression analysis was performed to identify the independent risk factors for CIN. Results The level of serum Lp(a) in STEMI patients was significantly higher in patients developed CIN than in those did not [(317.8±123.7) vs(173.1±76.2)mg/L, P<0.01]. After adjusted for age, diabetes, creatinine clearance and homocysteine etc, multivariate Logistic regression analysis showed that an elevated Lp(a) level was an independent risk factor for CIN in STEMI patients after PCI(OR=1.199,95% CI 1.150-1.251,P<0.01). Conclusion Elevated serum Lp(a) level may be an independent risk factor for the occurrence of CIN in patients with STEMI after PCI.
引文
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[14] 鄢高亮,孔文杰,王栋,等.血浆同型半胱氨酸水平对急性冠状动脉综合征患者介入治疗后对比剂肾病的影响[J].中华心血管病杂志,2016,44(1):32-37.
[2] Qin S,Liu J,Jiang HX,et al.Association between baseline lipoprotein(a) levels and restenosis after coronary stenting:meta-analysis of 9 cohort studies[J].Atherosclerosis,2013,227(2):360-366.
[3] 魏雯,涂梅,陈彤,等.脂蛋白(a)对糖尿病肾病早期诊断和病情监测的意义[J].中华内分泌代谢杂志,2016,32(1):52-55.
[4] 张俊林,刘芳.肾小球基底膜与肾脏疾病[J].中华肾脏病杂志,2017,33(11):873-877.
[5] 中华医学会血管分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2010,38(3):375-690.
[6] Andarssy KM.Comments on "KDIGO 2012 clinincal practice guideline for the evaluation and management of chronic kidney disease"[J].Kidney Int,2013,84(3):622-623.
[7] Elkind MS,Tai W,Coates K,et al.High-sensitivity C-reactive protein,lipoprotein-associated phospholipase A2,and outcome after ischemic stroke[J].Arch Int Med,2006,166(19):2073-2080.
[8] Zhao SP,Xu DY.Oxidized lipoprotein (a) enhanced the expression of P-selectin in cultured human umbilical vein endothelial cells[J].Thromb Res,2000,100(6):501-510.
[9] Gao F,Zhou YJ,Zhu X,et al.C-reactive protein and the risk of contrast-induced acute kidney injury in patients undergoing percutaneous coronary intervention[J].Am J Nephrol,2011,34(3):203-210.
[10] Valdete TS,Luljeta B,Emrush K.Lipoprotein(a) as an acute phase reactant in patients on chronic hemodialysis[J].Bosn J Basic Med Sci,2010,10(1):19-25.
[11] Wang R,Zhang K,Li S,et al.Apolipoprotein (a) impairs endothelial progenitor cell-mediated angiogenesis[J].DNA Cell Biol,2013,32(5):243-251.
[12] Sun N,Wang H,Wang L.Vaspin alleviates dysfunction of endothelial progenitor cells induced by high glucose via PI3K/Akt/eNOS pathway[J].Int J Clin Exp Pathol,2015,8(1):482-489.
[13] Li J,Yu L,Zhao Y,et al.Thymosin β4 reduces senescence of endothelial progenitor cells via the PI3K/Akt/eNOS signal transduction pathway[J].Mol Med Rep,2013,7(2):598-602.
[14] 鄢高亮,孔文杰,王栋,等.血浆同型半胱氨酸水平对急性冠状动脉综合征患者介入治疗后对比剂肾病的影响[J].中华心血管病杂志,2016,44(1):32-37.