nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное обществоnid-537Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESТромболизис и острое повреждение почек у больных с инфарктом миокардаThrombolysis and acute kidney injury in patients with myocardial infarctionМензоровМ. В.MenzorovM. V.noemail@neicon.ruШутовА. М.ShutovA. M.amshu@mail.ruСеровВ. А.SerovV. A.noemail@neicon.ruМакееваЕ. Р.MakeevaE. R.noemail@neicon.ruУльяновский государственный университет, г. УльяновскРоссияUlyanovsk State UniversityRussian Federation201413092024161162168Copyright © Мензоров М.В., Шутов А.М., Серов В.А., Макеева Е.Р., 20242024Мензоров М.В., Шутов А.М., Серов В.А., Макеева Е.Р.Menzorov M.V., Shutov A.M., Serov V.A., Makeeva E.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/537

Целью исследования явилась оценка частоты и тяжести острого повреждения почек (ОПП) у больных с острым инфарктом миокарда с подъемом сегмента ST (ОИМпST), которым проводился тромболизис альтеплазой или стрептокиназой. Материал и методы. Обследовано 292 больных с ОИМпST: у 170 (58%) применялась стрептокиназа, у 122 (42%) - альтеплаза. Мужчин было 227 (78%), женщин - 65 (22%), средний возраст составил 58 ± 11 лет. Критерием исключения из исследования было проведение коронарографии в остром периоде инфаркта миокарда. Результаты. Тромболизис был эффективен у 213 (73%) больных. Достоверных различий в эффективности тромболизиса при использовании стрептокиназы или альтеплазы не было (÷2 = 1,14; p = 0,28). ОПП по динамике креатинина диагностировано у 60 (35%) больных, кому вводилась стрептокиназа и у 12 (10%) - альтеплаза (÷2 = 15,75; p = 0,0001). При этом тяжесть ОПП у больных, подвергнутых тромболизису стрептокиназой, была достоверно выше (÷2 = 14,93; p = 0,0001). Снижение систолического артериального давления ниже 90 мм рт. ст. во время введения стрептокиназы наблюдалось чаще - у 26 (15%) больных, - чем при введении альтеплазы - у 5 (4%) (÷2 = 9,38; p = 0,002). В период госпитализации умерло 18 (6%) больных, внутригоспитальная летальность у больных с ОПП была выше, чем у остальных пациентов. Заключение. Четверть больных с ОИМпST, которым проводился тромболизис, имели острое повреждение почек, частота и тяжесть которого выше при использовании в качестве тромболитического препарата стрептокиназы по сравнению с альтеплазой. Среди больных с ОИМпST с ОПП внутригоспитальная летальность выше, чем у остальных пациентов.

The aim of the study was examination of the incidence and severity of the acute kidney injury (AKI) in patients with acute myocardial infarction with ST-elevation (STEMI) after thrombolytic therapy with alteplase or streptokinase. Methods. 292 patients (227 men and 65 women, mean age 58 ± 11 years) with STEMI were studied. All patients received thrombolytic therapy: 170 received streptokinase, and 122 - alteplase. Coronary angiography in acute stage of myocardial infarction was exclusion criteria. AKI was defined according to KDIGO Guidelines. Results. Thrombolysis was effective in 213 (73%) patients. There was no statistically significant difference in effectiveness of thrombolysis in the groups of patients who received streptokinase or alteplase (÷2 = 1,14; p = 0,28). Seventy-two (25%) patients developed AKI: 60 (35%) received streptokinase and 12 (10%) - alteplase (÷2 = 15,75; p = 0,0001). The severity of AKI was higher in patients treated streptokinase than alteplase (÷2 = 14,93; p = 0,0001). The incidence of arterial hypotension as complication of fibrynolythic administration was higher in the group of patients who received streptokinase (÷2 = 9,38; p = 0,002). The in-hospital mortality (6%) was significantly associated with AKI. Conclusions. Our results show that the incidence of AKI in patients with STEMI is 25%. The incidence and severity of AKI was higher in patients treated with streptokinase than those treated with alteplase. AKI was significantly associated with in-hospital mortality.

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