肌酐正常的冠心病患者肾小球滤过率对冠状动脉侧支循环的影响及其预后的临床研究

发布时间：2019-03-16 11:16

【摘要】：肌酐正常的冠心病患者肾小球滤过率对冠状动脉侧支及尿酸水平[(350.7±96.5)vs(324.0±90.1),P=0.019]出现升高。且差异均有统计学意义。Kaplan-Meier生存曲线分析结果显示在肌酐正常的冠心病患者中,随着eGFR水平的降低,MACE发生率出现明显上升趋势。结论:肌酐正常范围内的冠心病患者肾小球滤过率是侧支循环不充分重要预测因素。而且可以有效预测其未来的不良预后。目的:初步探讨在肌酐正常范围内的冠心病患者肾小球滤过率(e GFR)对冠状动脉侧支循环的影响及其预后。方法:入选我院心内科导管室2013-05至2014-04首次行冠脉造影结果示严重血管狭窄(狭窄程度≥95%)且肌酐正常的患者194例。根据造影侧支循环Rentrop分级将患者分为侧支循环建立不充分组(Rentrop分级0~1级,共113例)和侧支循环建立充分组(Rentrop分级2~3级,共81例),记录患者的年龄、性别、既往史、血肌酐值、空腹血糖、血脂水平等,通过肾脏疾病膳食改良(MDRD)研究公式估测e GFR,采用多因素Logistic回归模型分析冠脉侧支循环不充分与e GFR的相关性。对入选的患者进随访,平均随访时间为(8.31±6.02)个月,以发生MACE作为终点事件,并按有无MACE分为两组,比较两组间的基线资料,最后将全体入选患者按e GFR水平分为高中低三组,并用Kaplan-Meier生存曲线进行分析。结果:当血清肌酐处于正常范围时,e GFR水平在侧支循环不充分组较充分组更低[(78.7±20.5)ml/(min·1.73m-2)vs(89.6±3.2 ml/(min·1.73m-2),P=0.012],侧支循环不充分组的空腹血糖值[(7.5±3.4)mmol/L vs(6.7±2.8)mmol/L,P=0.003],高敏C反应蛋白(hs-CRP)水平[(2.7±0.8)mg/L vs(2.3±0.6)mg/L,P=0.029]较侧支循环充分组更高,Gensini评分(7.7±3.9 vs 9.1±5.0,P=0.004)较侧支循环充分组更低,差异有统计学意义。多因素Logistic回归分析显示,e GFR(OR=0.19,95%CI=0.14~0.22,P=0.027),hs-CRP(OR=1.58,95%CI=1.24~2.44,P=0.028),Gensini评分(OR=0.98,95%CI=0.97~0.99,P0.001),空腹血糖(OR=1.21,95%CI=1.06~1.41,P=0.002)是侧支循环不充分的独立危险因素。MACE组患者与无MACE组患者相比,e GFR水平出现降低[(73.5±18.6)vs(88.4±22.7),P=0.017],hs-CRP[(3.1±0.9)vs(2.6±0.9),P=0.012]
[Abstract]:The glomerular filtration rate (GFR) in patients with coronary heart disease with normal creatinine increased the level of coronary collateral and uric acid [(350.7 卤96.5) vs (324.0 卤90.1), P < 0.019]. The results of Kaplan-Meier survival curve analysis showed that the incidence of MACE increased with the decrease of eGFR level in CHD patients with normal creatinine. Conclusion: glomerular filtration rate is an important predictor of collateral insufficiency in patients with coronary heart disease within the normal range of creatinine. And it can effectively predict the future adverse prognosis. Aim: to investigate the effect of glomerular filtration rate (e GFR) on coronary collateral circulation and prognosis in patients with coronary heart disease (CHD) within the normal range of creatinine. Methods: from May 2013 to April 2014, 194 patients with severe stenosis (鈮，

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