内科

目的探讨急性ST段抬高型心肌梗死（ASTEMI）经皮冠状动脉介入（PCI）治疗术中慢血流对术后造影剂肾病（CIN）发生的影响。方法回顾性分析210例ASTEMI患者的临床资料，根据PCI术后是否发生CIN将患者分为CIN组和非CIN组。采用多因素Logistic回归模型分析ASTEMI患者PCI术后发生CIN的影响因素，采用Spearman相关分析探究ASTEMI患者PCI治疗术中慢血流与术后发生CIN的相关性。结果 210例ASTEMI患者，46例PCI术后发生CIN，发生率为21.9%。CIN组和非CIN组患者性别、年龄、身体质量指数、吸烟史、既往史（高血压、糖尿病、高脂血症、PCI、脑卒中/短暂性脑缺血发作）、收缩压、舒张压、病变血管支数≥2者占比、罪犯血管、入院Killip分级、心室射血分数、白细胞计数、血红蛋白水平、血小板计数、血尿素氮水平、术前TIMI分级比较，差异均无统计学意义（均P>0.05）；CIN组患者心率、造影剂使用剂量、血清肌酐（Scr）水平、慢血流发生率均快/大/高于非CIN组患者，两组患者术后TIMI分级差异有统计学意义（均P<0.05）。多因素Logistic回归分析结果显示，心率快、造影剂使用剂量大、Scr水平高、术中发生慢血流均为ASTEMI患者PCI术后发生CIN的独立危险因素，术后TIMI分级3级为保护因素（均P<0.05）。ASTEMI患者PCI术中发生慢血流与其术后发生CIN呈正相关（rs=0.233，P<0.05）。结论 PCI术中慢血流为ASTEMI患者PCI术后发生CIN的独立危险因素。PCI术中存在慢血流的ASTEMI患者需要采取切实有效的方法进行干预，以减少PCI术后CIN的发生，改善患者预后。

Objective To explore the effect of slow blood flow during percutaneous coronary intervention (PCI) on the occurrence of postoperative contrast-induced nephropathy (CIN) in acute ST segment elevation myocardial infarction (ASTEMI). Methods The clinical data of 210 ASTEMI patients were retrospectively analyzed, and the patients were divided into a CIN group or a non-CIN group according to whether they developed CIN after PCI. The multivariate logistic regression model was used to analyze influencing factors for CIN in ASTEMI patients after PCI, and the Spearman rank correlation analysis was used to explore the correlation between the slow blood flow during PCI and postoperative CIN in ASTEMI patients. Results Among the 210 ASTEMI patients, 46 developed CIN after PCI, with an incidence of 21.9%. There was no statistically significant difference in gender, age, body mass index, smoking history, past medical history (hypertension, diabetes mellitus, hyperlipidemia, PCI, stroke/transient ischemic attack), systolic blood pressure, diastolic blood pressure, the proportion of patients with lesional blood vessel count ≥2, culprit blood vessel, Killip classification at admission, ventricular ejection fraction, white blood cell count, hemoglobin level, platelet count, blood urea nitrogen level, or preoperative TIMI grade between the CIN group and the non-CIN group (all P>0.05); the heart rate, contrast agent dose, serum creatinine (Scr) level, and incidence of slow blood flow in the CIN group were faster/larger/higher than those in the non-CIN group, and there was a statistically significant difference in the postoperative TIMI grade between the two groups (all P<0.05). The results of multivariate logistic regression analysis showed that a fast heart rate, a large dose of contrast agent, a high Scr level, and the occurrence of intraoperative slow blood flow were independent risk factors, while postoperative TIMI grade 3 was a protective factor for postoperative CIN in ASTEMI patients (all P<0.05). The occurrence of slow blood flow during PCI positively correlated with the occurrence of CIN after PCI in ASTEMI patients (rs=0.233, P<0.05). Conclusion Slow blood flow during PCI is an independent risk factor for CIN after PCI in ASTEMI patients. ASTEMI patients suffering from slow blood flow during PCI need to be intervened in a practical and effective way to reduce the occurrence of CIN after PCI and improve the prognosis for the patients.