nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2012-16-1-40-44nefr-562Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSОСТРОЕ ПОВРЕЖДЕНИЕ ПОЧЕК У БОЛЬНЫХ ИНФАРКТОМ МИОКАРДА С ПОДЪЕМОМ СЕГМЕНТА STACUTE KIDNEY INJURY AT PATIENTS WITH ST-ELEVATED MYOCARDIAL INFARCTIONМензоровМ. В.MenzorovM. V.

Кафедра терапии и профессиональных болезней, медицинский факультет

ШутовА. М.ShutovA. M.

Кафедра терапии и профессиональных болезней, медицинский факультет 

432063, г. Ульяновск - 63, а/я 4595. Тел.: (8422) 55-27-08 (раб); факс: (8422) 56-00-82

amshu@mail.ruСеровВ. А.SerovV. A.

Кафедра терапии и профессиональных болезней, медицинский факультет

МихайловаЕ. В.MichajlovaE. V.

Кафедра терапии и профессиональных болезней, медицинский факультет

КлимоваТ. В.KlimovaT. V.

отделение неотложной кардиологии

АстапенкоЕ. А.AstapenkoE. A.

Кафедра терапии и профессиональных болезней, медицинский факультет

Ульяновский государственный университетRussian FederationЦентральная городская клиническая больница г.УльяновскаRussian Federation2012100120121614044Copyright © Мензоров М.В., Шутов А.М., Серов В.А., Михайлова Е.В., Климова Т.В., Астапенко Е.А., 20122012Мензоров М.В., Шутов А.М., Серов В.А., Михайлова Е.В., Климова Т.В., Астапенко Е.А.Menzorov M.V., Shutov A.M., Serov V.A., Michajlova E.V., Klimova T.V., Astapenko E.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/562

ЦЕЛЬ ИССЛЕДОВАНИЯ. Оценить частоту и выраженность острого повреждения почек (ОПП) по критериям RIFLE и AKIN у больных острым инфарктом миокарда с подъемом сегмента ST (ОИМпST), уточнить связь ОПП с летальностью и эффективностью тромболитической терапии (ТЛТ). ПАЦИЕНТЫ И МЕТОДЫ. Обследовано 165 больных (мужчин – 134, женщин – 31, средний возраст 56,6±10,43 года) с ОИМпST, которым была выполнена ТЛТ. ОПП диагностировали и классифицировали по критериям RIFLE и AKIN по креатинину (RIFLECr, AKINCr) и диурезу (RIFLEou, AKINou). РЕЗУЛЬТАТЫ. ТЛТ была эффективна у 115 (70%) больных. Согласно критериям RIFLECr, ОПП диагностировано у 87 (53%), по критериям AKINCr – у 101 (61%) больного. Согласно критериям RIFLEou и AKINou ОПП наблюдалось у 56 (34%) пациентов. Умерли 9 (5%) больных. Логистический регрессионный анализ показал, что ОПП по RIFLEou или AKINou было независимо от возраста и времени, от возникновения характерной клинической картины до момента госпитализации, ассоциировано с внутригоспитальной летальностью (относительный риск 17,1; 95% ДИ 2,01–146,46; p=0,006). ЗАКЛЮЧЕНИЕ. Более половины больных ОИМпST имеют острое повреждение почек по критериям RIFLECr и AKINCr. Частота ОПП по RIFLEou и AKINou вдвое меньше по сравнению с оценкой по AKINCr и на 40% меньше по сравнению с оценкой по RIFLECr. Наличие острого повреждения почек ассоциировано с отсутствием эффекта от тромболитической терапии и повышенной внутригоспитальной летальностью.

AIM. To estimate frequency and intensity of acute kidney injury (AKI) by RIFLE and AKIN criteria at patients with ST-elevated myocardial infarction (STEMI), to specify connection between AKI and mortality and effectivness of thrombolytic therapy (TLT). PATIENTS AND METНODS. 165 patients (134 men and 31 women, average age 56,6±10,43 years) with STEMI, who were performed TLT. AKI was diagnosed and classified by RIFLE and AKIN criteria by creatinine (RIFLECr, AKINCr) and diuresis (RIFLEOU, AKINOU). RESULTS. TLT was effective at 115 patients (70%). According to RIFLECr AKI was diagnosed at 87 patients (53%), by AKINCr criteria – at 101 patients (61%). According to RIFLEOU and AKINOU criteria AKI was noticed at 56 patients (34%). 9 patients (5%) died. Logistic regression analysis showed that AKI about RIFLEOU and AKINOU was time and age independent from the beginning of characteristic clinical picture till hospitalization associated with intrahospital mortality (hazard ratio 17,1; 95% CI 2,01 – 146.46; p=0,006). CONCLUSION. More then half of patients with STEMI have AKI by RIFLECr and AKINCr criteria. AKI frequency by RIFLEOU and AKINOU is twice as little in comparison with evaluation by AKINCr and 40% fewer in comparison with evaluation by RIFLECr, AKI presence is associated with effect absence from thrombolytic therapy and increased intrahospital mortality.

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The authors declare that there are no conflicts of interest present.