血漿尿素氮水平對急性ST段抬高型心肌梗塞患者死亡率的預測作用_《華西醫學》

作者：

王琳凌 , 王平 , 劉曉康 , 林靚

四川省涼山州第一人民醫院心內科,四川西昌 615000;

關鍵詞：

血漿尿素氮腎小球濾過率心肌梗塞預后

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導出 下載 收藏 掃碼 引用

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目的:腎功能不全在急性冠脈綜合癥及其它心血管疾病中通常伴隨著較高的死亡率。而血漿尿素氮是反映血液動力學改變及腎臟灌注改變的非常敏感的指標。本試驗研究血漿尿素氮水平的高低對于急性ST段抬高型心肌梗塞患者死亡率的預測作用。方法:研究300名患急性ST段抬高型心肌梗塞患者長程的死亡率與入院時血漿尿素氮水平及住院時血漿尿素氮水平升高之間的關系。結果:在平均隨訪27個月,56(185%)個患者死亡。使用生存分析對于血漿尿素氮水平升高與血漿尿素氮水平正常兩組患者進行研究,用log-rank檢驗將兩組數據進行比較,有明顯統計學意義,P lt;0.001。結論:對于患急性ST段抬高型心肌梗塞患者的長期死亡率,入院時的血漿尿素氮水平是一個獨立的預測因素。BUN和BUN/creatinine比值的增高也能對患急性ST段抬高型心肌梗塞患者的長期死亡率提供一定的預測信息。同時,住院期間的BUN增高對于患急性ST段抬高型心肌梗塞患者的長期死亡率也能夠提供額外的預測信息。

引用本文： 王琳凌,王平,劉曉康,林靚. 血漿尿素氮水平對急性ST段抬高型心肌梗塞患者死亡率的預測作用. 華西醫學, 2009, 24(8): 2123-2125. doi: 復制

1.	黃慶武, 呂留彩, 王厚行,等.BXC1型脲酶電極測定血漿尿素氮的初步探討[J].中華醫學檢驗雜志,1990, 13(5): 258-260.
2.	王繼貴,譯.急性冠脈綜合征病人早期危險性評價[J].實驗與檢驗醫學, 2008, 26(5): 570.
3.	SHLIPAK MG, HEIDENREICH PA, NOGUCHI H, et al.Association of renal insufficiency with treatment and outcomes after myocardial infarction in elderly patients[J]. Ann Intern Med, 2002,137(9):555–562.
4.	鐘光珍, 那開憲.ACC/AHA不穩定型心絞痛和非ST段抬高心肌梗死治療指南(2007年修訂版)解讀(3)[J].中國臨床醫生,2008,36(11):74-75.
5.	高璐, 秦明照, 常志文.代謝綜合征患者血尿酸水平與冠脈病變的關系[J].中國醫刊,2008,43(11):33-35.
6.	ANAVEKAR NS, MCMURRAY JJ, VELAZQUEZ EJ, et al. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction[J]. N Engl J Med, 2004,351(6):1285–1295 .
7.	朱政斌, 張瑞巖, 沈衛峰.慢性腎病合并冠狀動脈粥樣硬化的他汀治療[J].臨床內科雜志,2008,25(7): 449-451.
8.	FONAROW GC, ADAMS JR KF, ABRAHAM WT, et al. Risk stratification for inhospitalmortality in acutely decompensated heart failure: classification and regression tree analysis[J]. Jama,2005,293(10):572–580.
9.	KIRTANE AJ, LEDER DM, WAIKAR SS,et al. Serum blood urea nitrogen as an independent marker of subsequent mortality among patients with acute coronary syndromes and normal to mildly reduced glomerular filtration rates[J]. J Am Coll Cardiol, 2005,45(2):1781–1786.
10.	ALPERT JS, THYGESEN K, ANTMAN E, et al. Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction[J]. J Am Coll Cardiol,2000,36(9):959–969.
11.	王樂豐, 劉宇.慢性腎功能不全合并急性冠脈綜合征的抗栓治療[J].臨床內科雜志,2008,25(7): 446-448.
12.	MCCULLOUGH PA. Why is chronic kidney disease the “spoiler” for cardiovascular outcomes[J]? J Am Coll Cardiol, 2003,41(2):725–728.
13.	BEATTIE JN, SOMAN SS, SANDBERG KR, et al. Determinants of mortality after myocardial infarction in patients with advanced renal dysfunction[J]. Am J Kidney Dis, 2001,37(11):1191–1200.
14.	ARONSON D, MITTLEMAN MA, BURGER AJ. Elevated blood urea nitrogen level as a predictor of mortality in patients admitted for decompensated heart failure[J]. Am J Med, 2004,116:466–473.
15.	BROSIUS III FC, HOSTETTER TH, KELEPOURIS E, et al. Detection of chronic kidney disease in patients with or at increased risk of cardiovascular disease: a science advisory from the American Heart Association[J]. J Am Coll Cardiol,2002,38(5):751-762.

1. 黃慶武, 呂留彩, 王厚行,等.BXC1型脲酶電極測定血漿尿素氮的初步探討[J].中華醫學檢驗雜志,1990, 13(5): 258-260.
2. 王繼貴,譯.急性冠脈綜合征病人早期危險性評價[J].實驗與檢驗醫學, 2008, 26(5): 570.
3. SHLIPAK MG, HEIDENREICH PA, NOGUCHI H, et al.Association of renal insufficiency with treatment and outcomes after myocardial infarction in elderly patients[J]. Ann Intern Med, 2002,137(9):555–562.
4. 鐘光珍, 那開憲.ACC/AHA不穩定型心絞痛和非ST段抬高心肌梗死治療指南(2007年修訂版)解讀(3)[J].中國臨床醫生,2008,36(11):74-75.
5. 高璐, 秦明照, 常志文.代謝綜合征患者血尿酸水平與冠脈病變的關系[J].中國醫刊,2008,43(11):33-35.
6. ANAVEKAR NS, MCMURRAY JJ, VELAZQUEZ EJ, et al. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction[J]. N Engl J Med, 2004,351(6):1285–1295 .
7. 朱政斌, 張瑞巖, 沈衛峰.慢性腎病合并冠狀動脈粥樣硬化的他汀治療[J].臨床內科雜志,2008,25(7): 449-451.
8. FONAROW GC, ADAMS JR KF, ABRAHAM WT, et al. Risk stratification for inhospitalmortality in acutely decompensated heart failure: classification and regression tree analysis[J]. Jama,2005,293(10):572–580.
9. KIRTANE AJ, LEDER DM, WAIKAR SS,et al. Serum blood urea nitrogen as an independent marker of subsequent mortality among patients with acute coronary syndromes and normal to mildly reduced glomerular filtration rates[J]. J Am Coll Cardiol, 2005,45(2):1781–1786.
10. ALPERT JS, THYGESEN K, ANTMAN E, et al. Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction[J]. J Am Coll Cardiol,2000,36(9):959–969.
11. 王樂豐, 劉宇.慢性腎功能不全合并急性冠脈綜合征的抗栓治療[J].臨床內科雜志,2008,25(7): 446-448.
12. MCCULLOUGH PA. Why is chronic kidney disease the “spoiler” for cardiovascular outcomes[J]? J Am Coll Cardiol, 2003,41(2):725–728.
13. BEATTIE JN, SOMAN SS, SANDBERG KR, et al. Determinants of mortality after myocardial infarction in patients with advanced renal dysfunction[J]. Am J Kidney Dis, 2001,37(11):1191–1200.
14. ARONSON D, MITTLEMAN MA, BURGER AJ. Elevated blood urea nitrogen level as a predictor of mortality in patients admitted for decompensated heart failure[J]. Am J Med, 2004,116:466–473.
15. BROSIUS III FC, HOSTETTER TH, KELEPOURIS E, et al. Detection of chronic kidney disease in patients with or at increased risk of cardiovascular disease: a science advisory from the American Heart Association[J]. J Am Coll Cardiol,2002,38(5):751-762.

《華西醫學》

血漿尿素氮水平對急性ST段抬高型心肌梗塞患者死亡率的預測作用

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《華西醫學》

血漿尿素氮水平對急性ST段抬高型心肌梗塞患者死亡率的預測作用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

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