Single-center Clinical Study Of Acute Renal Injury Associated With Myocardial Infarction

Objective: To explore the risk factors of AKI(Acute Kidney Injury)caused by AMI(Acute Myocardial Infarction)and to establish the miRNA map of Acute Renal Injury in patients with AMI-AKI and healthy controls in peripheral blood,and screen out the differential miRNA.Methods: 1.Patients admitted to the department of CCU of the First Affiliated Hospital of Xinjiang Medical University and diagnosed with acute myocardial infarction from January 1,2016 to December 31,2020 were collected.Patients were divided into AMI-AKI group and non-AKI group according to the presence or absence of AKI.Demographic,clinical biochemical indicators were analyzed.2.Six patients in AMI-AKI admitted to the department of CCU of the First Affiliated Hospital of Xinjiang Medical University from January to March 2020 were collected.According to age,sex and ethnic group matching at 1:1,six healthy people were selected as controls.The peripheral blood samples of the two groups were tested by high-throughput miRNA sequencing.Results: 1.Multivariate Logistic regression analysis shown that diastolic blood pressure(DBP)at 68-80 mm Hg(OR:0.402,95%Cl:0.194-0.832),urea nitrogen(OR:2.242,95%,Cl:1.098-4.578),creatinine(OR:2.856,95%Cl:1.330-6.132)and serum uric acid(OR:3.447;95%Cl:1.706-6.963),AST(OR:2.263,95%Cl:1.103-4.644)and left ventricular ejection fraction(OR:0.480,95%Cl:0.257-0.897)were independent risk factors of AKI in patients with AMI.ROC curve shown that there was the significant correlation between AKI and serum uric acid(AUC:0.591,P < 0.001)in patients with AMI.2.According to the location of infarction indicated by electrocardiogram,the top three infarction types in AMI-AKI were other types of myocardial infarction(74 cases,39%),anterior wall myocardial infarction(40 cases,21%)and inferior wall myocardial infarction(23 cases,12%).On the other hand in Non-AKI,the top three infarction types were other types of myocardial infarction(34 cases,31%),inferior wall myocardial infarction(26cases,24%)and anterior wall myocardial infarction(18 cases,16%).In AMI-AKI patients,we further described the AKI staging distribution according to the above statistical results.The results shown that there was no significant difference in age,systolic blood pressure,diastolic blood pressure,heart rate,hospital stay,Killip grade,smoking history and drinking history among AKI1,AKI2 and AKI3 groups.3.In AMI-AKI group and the control group,a total of 977-1054 miRNAs expression was detected in the peripheral blood.In these expressed miRNA,it reached the requirement of statistical significance(p< 0.05).Among them,21 miRNA were up-regulated in AKI group and 48 miRNA were down.Conclusion: 1.Diastolic blood pressure at 68-80 mm Hg,blood urea nitrogen,creatinine,serum uric acid,AST and left ventricular ejection fraction were independent risk factors for AKI in patients with AMI.The incidence of AKI in patients with AMI has the greatest correlation with serum uric acid,and the increase of serum uric acid is an important index to predict the occurrence of AKI in patients with AMI.2.According to the location distribution of myocardial infarction in patients with ECG,AMI patients with or without AKI,accounting for the top three types of myocardial infarction are other types of myocardial infarction,anterior wall myocardial infarction and inferior wall myocardial infarction.In ami-aki patients,there was no significant difference in AKI severity among the three groups according to AKI stage.3.Three miRNA co-expressed in both human and animal models were selected as biomarkers of AMI-AKI,which were miR-148a-3p,miR-23a-3p and miR-20a-5p.Respectively,among them,the expression of miR-148a-3p and miR-23a-3p was up-regulated in AMI-AKI,while the miR-20a-5p was decreased.