目的：探讨急性 ST 段抬高型心肌梗死（ST segment elevation myocardial infarction ，STEMI）合并肾功能不全（re－nal insufficiency ，RI）患者的临床特征，并分析肾功能不全对 STEMI 患者住院期间预后的影响。方法对温州医科大学附属第一医院2007年3月至2012年3月收治的950例急性 STEMI 患者资料进行回顾性分析，根据简化 MDRD（modifi－cation of diet in renal disease）方程计算患者的肾小球滤过率（estimated glomerular filtration rate ，eGFR），将患者分为肾功能正常组（eGFR ≥90ml・min －1・1.73m －2）、轻度 RI 组（60ml・min －1・1.73m －2≤ eGFR ＜90ml・min －1・1.73m －2）及中重度 RI 组（eGFR ＜60ml・min －1・1.73m －2）。分析 STEMI 合并 RI 患者的临床特征及对住院期间预后的影响。结果950例急性STEMI 患者中肾功能正常患者共444例（46.74％），轻度 RI 组351例（36.95％），中重度 RI 组155例（16.32％）。 RI 患者年龄更大，女性比例更高，吸烟、饮酒者更少，既往存在高血压病、糖尿病、高脂血症、陈旧性脑梗死患者比例更高，病程中出现心房颤动、Ⅱ／Ⅲ度房室传导阻滞更多（P＜0.05）。同时 RI 患者更易合并冠状动脉三支病变及左主干、右冠状动脉、回旋支严重病变，但接受急诊冠状动脉血运重建比例更低（P＜0.05）。多因素 Logistic 回归分析显示相对于肾功能正常组，中重度 RI 是 STEMI 患者住院期间出现心力衰竭（OR ＝2.25，95％ CI ：1.36～3.71）、心源性休克（OR ＝4.13，95％ CI ：1.52～11.22）的独立危险因素，而轻度 RI（OR ＝2.20，95％ CI ：1.27～6.70）及中重度 RI（OR ＝14.54，95％ CI ：6.12～34.53）均为住院期间出现全因死亡的的独立危险因素。结论肾功能不全是 STEMI 患者住院期间出现全因死亡、心源性休克和心力衰竭的重要危险因素。%Objective To characterize clinical features of acute ST segment elevation myocardial infarction (STEMI) patients with re-nal insufficiency (RI) and to explore impact of renal insufficiency (RI) on adverse outcomes of STEMI patients in hospital .Methods A retrospective study was conducted among 950 patients who were hospitalized with acute STEMI in the first hospitalization of Wen -zhou Medical University from March 2007 to March 2012 .Estimation of glomerular filtration rate (eGFR) was calculated using the modified abbreviated Modification of Diet in Renal Disease equation .The patients were divided into three groups according to eGFR , normal renal function (eGFR ≥ 90ml・min - 1・1 .73m - 2 ) ,mild RI (60ml・min - 1・1 .73m - 2 ≤ eGFR < 90ml・min - 1・1 .73m - 2 ) and moderate or severe RI (eGFR < 60ml・min - 1・1 .73m - 2) .The clinical features and hospital adverse outcomes were analyzed .Results Among the 950 STEMI patients ,444 (46 .74% ) patients had normal renal function ,351 (36 .95% ) patients had mild RI ,155 (16 . 32% ) patients had moderate or severe RI ,RI patients were more likely to be elderly ,female ,non drinker and non smokers ,and they were more likely to have a past history of hypertension ,diabetes ,hyperlipemia and cerebral infarction and to have complication of a -trial fibrillation and II/III degree atrioventricular block( P < 0 .05) .In addition ,RI patients were significantly more likely to have three vessel disease and more likely to have severe stenosis in left main ,right coronary artery and left circumflex artery ,but RI pa-tients received primary percutaneous coronary intervention less frequently than those with normal renal function (P< 0 .05) .Multivari-ate logistic regression analysis indicated that moderate or severe RI remained an independent predictor for cardiogenic shock (OR = 4 . 13 ,95% CI :1 .52 11 .22) and heart failure (OR = 2 .25 ,95% CI :1 .36 3 .71) for STEMI patients .Mild RI (OR = 2 .20 ,95% CI :1 . 27 6 .70) and moderate or severe RI (OR = 14 .54 ,95% CI :6 .12 34 .53) both remained independent predictors for all cause hospital mortality for STEMI patients .Conclusions RI was a major risk factor for all cause hospital mortality ,cardiogenic shock and heart failure for STEMI patients .
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