中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2008年
9期
735-738
,共4页
张强%马长生%聂绍平%吕强%康俊平%刘小慧
張彊%馬長生%聶紹平%呂彊%康俊平%劉小慧
장강%마장생%섭소평%려강%강준평%류소혜
冠状动脉疾病%肾功能衰竭,慢性%血管成形术
冠狀動脈疾病%腎功能衰竭,慢性%血管成形術
관상동맥질병%신공능쇠갈,만성%혈관성형술
Coronary diseases%Kidney failure,chronic%Angioplasty
目的 了解未诊断慢性肾脏疾病(CKD),且接受血运重建冠心病患者的肾功能状态,探讨肾功能与患者预后之间的关系,明确选择合理的血运重建方式能否使患者获益.方法 入选无肾脏病史、并接受血运苇建治疗的冠心病患者,肾功能根据肌酐清除率(CrCl)分级,评价不同肾功能患者的临床特征、冠状动脉病变和血运重建情况以及临床预后.结果 入选患者2896例,肾功能不全患者的住院期和随访期病死率以及随访期卒中的发生率高于肾功能正常患者.多因素回归分析显示,血运重建术后死亡的独立危险因素分别为:血运重建方式、年龄和CrCl.在肾功能正常和轻度肾功能不全的冠心病患者中,经皮冠状动脉介入术组的病死率显著低于冠状动脉旁路移植术组.结论 在未诊断CKD的冠心病患者中,轻、中度的肾功能不全并不少见,并与血运重建术后的不良事件相关.冠状动脉血运重建方式影响肾功能正常或轻度不全患者的预后.
目的 瞭解未診斷慢性腎髒疾病(CKD),且接受血運重建冠心病患者的腎功能狀態,探討腎功能與患者預後之間的關繫,明確選擇閤理的血運重建方式能否使患者穫益.方法 入選無腎髒病史、併接受血運葦建治療的冠心病患者,腎功能根據肌酐清除率(CrCl)分級,評價不同腎功能患者的臨床特徵、冠狀動脈病變和血運重建情況以及臨床預後.結果 入選患者2896例,腎功能不全患者的住院期和隨訪期病死率以及隨訪期卒中的髮生率高于腎功能正常患者.多因素迴歸分析顯示,血運重建術後死亡的獨立危險因素分彆為:血運重建方式、年齡和CrCl.在腎功能正常和輕度腎功能不全的冠心病患者中,經皮冠狀動脈介入術組的病死率顯著低于冠狀動脈徬路移植術組.結論 在未診斷CKD的冠心病患者中,輕、中度的腎功能不全併不少見,併與血運重建術後的不良事件相關.冠狀動脈血運重建方式影響腎功能正常或輕度不全患者的預後.
목적 료해미진단만성신장질병(CKD),차접수혈운중건관심병환자적신공능상태,탐토신공능여환자예후지간적관계,명학선택합리적혈운중건방식능부사환자획익.방법 입선무신장병사、병접수혈운위건치료적관심병환자,신공능근거기항청제솔(CrCl)분급,평개불동신공능환자적림상특정、관상동맥병변화혈운중건정황이급림상예후.결과 입선환자2896례,신공능불전환자적주원기화수방기병사솔이급수방기졸중적발생솔고우신공능정상환자.다인소회귀분석현시,혈운중건술후사망적독립위험인소분별위:혈운중건방식、년령화CrCl.재신공능정상화경도신공능불전적관심병환자중,경피관상동맥개입술조적병사솔현저저우관상동맥방로이식술조.결론 재미진단CKD적관심병환자중,경、중도적신공능불전병불소견,병여혈운중건술후적불량사건상관.관상동맥혈운중건방식영향신공능정상혹경도불전환자적예후.
This study determined the profile of renal insufficiency in patients without chronic kidney disease(CKD)undergoing coronary revascularization and elucidated the effect of renal insufficiency of different degrees on clinical outcomes after revascularization and examined whether the reasonable choice of the mode of revasoularization could favourably influence prognosis.Methods Patients undergoing coronary revascularization were grouped by estimated creatinine clearance(CrCl)(Group Ⅰ,CrCl≥90 ml/min;Group Ⅱ,60 CrCl<90 ml/min;Group Ⅲ,30≤CrCl<60 ml/min;Group Ⅳ,CrCl<30 ml/min).We evaluated the relationship between the CrCl and the clinical outcomes of all of the patients.Results The mean Scr level of 2896 patients was(80.0±35.4)μmol/L There were 1035 patients(35.7%)in Group Ⅰ,1337 patients(46.2%)in Group Ⅱ,524 patients(18.1%)in Group Ⅲ and no patient in Group Ⅳ.During hospitalization,significant difference was found among Group Ⅰ-Ⅲ on mortality
(1.0%.2.5% and 2.9%,P=0.009)and major adverse cardiar cerebra tvents(MACCE)(1.4%,3.5% and 4.6%.P=0.001).Compared with the normal renal function group,there were significantly higher rate of mortality(2.5% vs.1.0%,P=0.007).new-onset myocardial infarction(1.0% vs.0.2%,P=0.018)and MACCE(3.5% vs.1.4%,P=0.002)in miid renal insufficiency(Group Ⅱ).During follow-up,there were significant difference among Group Ⅰ-Ⅲ on mortality(2.0%,3.0% and 5.7%,P=0.002),stroke(1.0%,1.8% and 3.1%,P=0.023)and MACCE(9.9%,10.3% and 16.6%,P=0.001).The independent risk factors for all-cause death in patients after revascularization were the mode of revascularization(OR 8.332,95% CI 2.386-22.869,P=0.001).age(OR 1.184,95% CI 1.020-1.246,P=0.001).and the level of CrCl(OR 0.503,95% CI 0.186-0.988,P=0.045).In patients with normal renal function and mild renal insufficiency.the all-cause mortality after PCI was significantly lower that than after CABG(both P<0.01).Conclusions Renal insufficiency is common in patients without CKD undergoing coronary revascularization,even mild renal insufficiency is correlated with adverse clinical outcomes after revascularization.In patients with normal renal function or mild renal insufficiency,the mode of revascularization might lead to a prognostic difference.