Early Diagnosis And Risk Factors Of Cardiorenal Syndrome Type 1 In Patients With Acute Myocardial Infarction

Objective: 1. To investigate the early diagnostic value of detecting neutrophil gelatinase-associated lipocalin(NGAL)、cystatin C(Cys-C)、interleukin-18(IL-18)、β2-microglobulin(β2-MG)solely and jointly of cardiorenal syndrome type 1(CRS1) after acute myocardial infarction(AMI). 2. To analyze the risk factors of cardiorenal syndrome type 1 in patients with acute myocardial infarction and provide a basis for diagnosis、traetment and prevention of CRS1.Methods: 1. 142 cases of patients diagnosed AMI and accepted Emergency percutaneous coronary intervention(PCI)therapy were selected in Peopleˊs Hospital of Hunan Province from January to December,2014. By detecting patientsˊserum creatinine(Scr) in the PCI preoperative and postoperative 2 h, 4 h, 6 h, 8 h, 12 h, 24 h, 48 h to diagnose with Acute Kidney Injury(AKI).Then according to patients who whether diagnosed AKI divided into CRS1 group and non- CRS1 group.Using Enzyme linked immunosorbent(ELISA) to detecte two groups of patientsˊserum NGAL, Cys- C, IL-18 and beta 2- MG level in the PCI preoperative and postoperative 2 h, 4 h, 6 h, 8 h, 12 h, 24 h and observe the dynamic changes of the various indicators.Applied Receiver Operating Characteristic(ROC)and Area under the curve(AUC)to analyse and evaluate the value of detecting solitudly and affiliatly four indicators for early diagnosis for AMI with CRS1. 2. The medical date of hospitalized patients with AMI from January,2013 to December,2014 in Hunan Provincial People’s Hospital were reviewed. The total of 316 patients with AMI were divided into CRS1 group and non-CRS1 group. The univariate comparison and multivariate logistic regression analysis were performed to obtain the CRS1 risk factors.Results: 1. The value of joint detection of NGAL、Cys-C、IL-18、β2-MG in serum for early diagnosis of CRS1 after AMI. 1.1 There where 28 cases had AKI in the patients with AMI accept Emergency percutaneous coronary intervention(PCI)therapy,incidence rate of CRS1 is about 19.7%.Comparison of two groups of general information: two groups had no significant difference in gender, hypertension, diabetes, hyperlipidemia, smoking history, ACEI/ARB and statins(P > 0.05). The age of the CRS1 I group, the amount of contrast agent, door-to-balloon times was significantly higher than the control group, the use of beta blocker was lower than that of non-CRS1 group, the difference was statistically significant(P < 0.05). 1.2 In CRS1 group,Scr were significantly increased after postoperative 24 h,reached peak at 48 h,The levels of NGAL、Cys-C、IL-18 and β2-MG began to increase respectively at postoperative 2h、6h、2h、6h,and reached peak at postoperative 2h、12h、4h、24h.There was significant difference in the levels and reached peak of NGAL、Cys-C、IL-18、β2-MG between the two group(all P<0.05). 1.3 According to the ROC curve,s NGAL、s Cys-C、s IL-18、sβ2-MG are ideal for predicting the CRS1 during early period after AMI,the ROC-AUC of s NGAL、s Cys-C、s IL-18、sβ2-MG were 0.93、0.90、0.85、0.83。The sensitivity and specificity of early diagnosis of AKI will further improve when detect the four markers jointly,yielded a ROC-AUC of 0.96. 2. The risk factors of cardiorenal syndrome type 1 in patients with acute myocardial infarction. 2.1 In the 316 AMI patients,CRS1 was found in 79 patients(23.7%). Age、history of diabetes, Killip classification,left ventricular ejection fraction(LVFF),baseline serum creatinine, blood urea nitrogen,uric acid,baseline evaluated glomerular filtration rate(e GFR),serum sodium,the left anterior descending artery lesion,emergency PCI,β-blocker and angiotensin converting enzyme inhibitor/angiotensinreceptor antagonist(ACEI/ARB) are statistically different between CRS1 group and non-CRS1 group(all P<0.05). 2.2 Multivariate logistic regression showed that age, history of diabetes, Killip classification, reduced LVEF,reduced e GFR, hyponatremia, the left anterior descending artery lesionn,emergency PCI non-undergo and β-blocker non-use were independent risk factors for CRS1 after AMI.Conclusions: 1. Serum NGAL, Cys- C, IL- 18, β2- MG can be used as the early diagnosis markers of AMI patients complicated with AKI, the diagnosis time is earlier than Scr, and detecting jointly four indicators can improve the effect of early diagnosis of CRS1 after AMI. 2. CRS1 is a common complication in patients with AMI,age,history of diabetes,Killip classification,reduced LVEF,reduced e GFR,hyponatre- mia,the left anterior descending artery lesionn, emergency PCI non-undergo andβ-blocker non-use were were important risk factors for CRS1 after AMI.Our date suggest that patients with AMI should be more comprehensively assessed and monitored,thereby preventing the occurrence of CRS1.