| AIP及SIRI与高血压合并急性STEMI患者PCI术后对比剂急性肾损伤的相关性 |
| 投稿时间：2025-04-29 修订日期：2025-05-23 点此下载全文 |
| 引用本文：丁家辉,金靖昆,张熙绅,王琳升,张旭东,李文华,李珊珊.AIP及SIRI与高血压合并急性STEMI患者PCI术后对比剂急性肾损伤的相关性[J].医学研究杂志,2025,54(10):117-122 |
| DOI：
10.11969/j.issn.1673-548X.2025.10.021 |
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| 中文摘要:目的 探讨血浆致动脉粥样硬化指数(atherogenic index of plasma, AIP)和全身炎性反应指数(systemic inflammatory response index, SIRI)对高血压合并急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者接受经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)术后并发对比剂急性肾损伤(contrast-induced acute kidney injury, CI-AKI)的预测价值。方法 采用回顾性研究方法,纳入2021年1月～2025年4月就诊于徐州医科大学附属医院并接受PCI治疗的高血压合并急性STEMI患者964例。采用随机分组法按8∶2的比例划分为训练组(n=771)和验证组(n=193)。根据CI-AKI诊断标准,将训练组分为CI-AKI组(n=151)与非CI-AKI组(n=620),并对两组患者的基线资料进行比较。通过构建多因素Logistic回归模型筛选术后并发CI-AKI的独立预测因素,继而采用受试者工作特征(receiver operating characteristic, ROC)曲线评估AIP、SIRI及联合检测对高血压合并急性STEMI患者接受PCI治疗后并发CI-AKI的预测效能。结果 左心室射血分数(left ventricular ejection fraction, LVEF)、尿素代谢水平、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)、利尿剂、SIRI及AIP与高血压合并急性STEMI患者接受PCI术后发生CI-AKI存在显著相关性(P<0.05)。多因素Logistic回归分析结果显示,SIRI(OR=1.148,95%CI:1.060~1.244)与AIP(OR=5.946,95%CI:3.250~10.879)是CI-AKI的独立危险因素。ROC曲线分析结果显示,联合检测SIRI和AIP的曲线下面积为0.805(95%CI:0.774~0.835),其敏感度为70.8%,特异性为75.0%,显著优于单一指标(P<0.001)。限制性立方样条(restricted cubic spline, RCS)分析结果显示,当SIRI≥2.773或AIP≥2.089时,CI-AKI的发生风险随SIRI及AIP的升高而增加。结论 AIP与SIRI是高血压合并急性STEMI患者PCI术后发生CI-AKI的独立危险因素,联合检测可以提高高血压合并急性STEMI患者PCI术后CI-AKI的预测效能。 |
| 中文关键词:全身炎性反应指数 血浆致动脉粥样硬化指数 对比剂急性肾损伤 高血压 急性ST段抬高型心肌梗死 |
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| Correlation between AIP and SIRI with Contrast-induced Acute Kidney Injury after PCI in Hypertensive Patients Complicated with Acute STEMI. |
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| Abstract:Objective To investigate the predictive value of the atherogenic index of plasma (AIP) and systemic inflammatory response index (SIRI) for contrast-induced acute kidney injury (CI-AKI) in patients with hypertension complicated by acute ST-segment elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI). Methods A total of 964hypertensive patients with acute STEMI who underwent PCI treatment at the Affiliated Hospital of Xuzhou Medical University from January 2021 to April 2025 were retrospectively enrolled. Using a randomized grouping method, the sample was divided into the training group (n=771) and the validation group (n=193) in a ratio of 8∶2. According to the diagnostic criteria for CI-AKI, the training group was further divided into the CI-AKI group (n=151) and the non-CI-AKI group (n=620), with baseline characteristics compared between the two groups. Multivariate Logistic regression models were constructed to identify independent predictors of postoperative CI-AKI, followed by receiver operating characteristic (ROC) curve analysis to evaluate the predictive efficacy of AIP, SIRI, and their combined detection for CI-AKI occurrence after PCI treatment. Results Left ventricular ejection fraction (LVEF), urea metabolism level, high-density lipoprotein cholesterol (HDL-C), diuretics, SIRI, and AIP showed significant correlations with the occurrence of CI-AKI in hypertensive patients with acute STEMI after PCI (P<0.05). Multivariate Logistic regression analysis revealed that SIRI (OR=1.148,95%CI:1.060-1.244) and AIP (OR=5.946,95%CI:3.250-10.879) were independent risk factors for CI-AKI. The results of ROC curve analysis demonstrated that the combined detection of SIRI and AIP yielded an area under the curve of 0.805 (95%CI:0.774-0.835), with the sensitivity of 70.8% and the specificity of 75.0%, which was significantly better than that of individual indicators (P<0.001). The results of restricted cubic spline (RCS) indicated that when SIRI≥2.773 or AIP≥2.089, the risk of CI-AKI increased with rising levels of SIRI and AIP. Conclusion AIP and SIRI are independent risk factors for CI-AKI in hypertensive patients with acute STEMI after PCI, and their combined detection can improve the predictive efficacy of CI-AKI in hypertensive patients with acute STEMI following PCI. |
| keywords:Systemic inflammatory response index Atherogenic Index of plasma Contrast-induced acute kidney injury Hypertension ST-segment elevation myocardial infarction |
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