CAJ | 학술논문

目的肾脏病膳食改善（MDRD）方程估算的肾小球滤过率（eGFR）和尿蛋白定性分级结果联合分析，探讨不同程度的尿蛋白在冠状动脉介入治疗（ PCI）患者术后2年内预后预测的价值。方法将行PCI的1201例患者依据eGFR和尿蛋白定性分级结果分组，A组eGFR≥60 ml/min，尿蛋白定性阴性659例；B组eGFR≥60 ml/min，尿蛋白定性阳性（＋）269例；C组eGFR≥60 ml/min，尿蛋白定性阳性（＋＋～＋＋＋＋）40例；D组eGFR＜60 ml/min，尿蛋白定性阴性179例；E组eGFR＜60 ml/min，尿蛋白定性阳性（＋）33例；F组eGFR＜60 ml/min，尿蛋白定性阳性（＋＋～＋＋＋＋）21例。采用COX比例风险模型对患者预后进行生存分析，6组间生存曲线的比较使用Kaplan-Meier法，并用对数秩和分析（ Log rank ststistic ）进行组间比较。结果多因素分析校正身高体重指数、吸烟、年龄、性别、高脂血症、高血压、糖尿病、以前有无心肌梗死等危险因素后，发现PCI术后2年内，蛋白尿与发生心脏事件的相对危险度（ RR ）为1.772（95％ CI为1.163～2.699，P＝0.008）；A组与B组，D组与E组组间蛋白尿与心脏事件发生无统计学差异（ P＞0.05）；A组与C组组间蛋白尿与发生心脏事件的RR为4.117（95％CI为1.817～9.331，P＝0.001）；D组与F组组间蛋白尿与发生心脏事件的RR为5.471（95％CI为1.922～15.578，P＝0.001）；术后2年随访的生存曲线中，发现C组累计生存率低于D组，F组累计生存率明显低于A组和B、C、D、E组。6组患者的PCI术后生存率的组间比较差异有统计学意义（χ2＝11.476，P＝0.043）。结论 eGFR联合尿蛋白对冠心病患者做预后评估更有效；对于鉴定和治疗有心脏事件高发生率的冠心病患者，联合eGFR和尿蛋白定性不同水平进行术前评估，是一种简单有效的工具。
목적신장병선식개선（MDRD）방정고산적신소구려과솔（eGFR）화뇨단백정성분급결과연합분석，탐토불동정도적뇨단백재관상동맥개입치료（ PCI）환자술후2년내예후예측적개치。방법장행PCI적1201례환자의거eGFR화뇨단백정성분급결과분조，A조eGFR≥60 ml/min，뇨단백정성음성659례；B조eGFR≥60 ml/min，뇨단백정성양성（＋）269례；C조eGFR≥60 ml/min，뇨단백정성양성（＋＋～＋＋＋＋）40례；D조eGFR＜60 ml/min，뇨단백정성음성179례；E조eGFR＜60 ml/min，뇨단백정성양성（＋）33례；F조eGFR＜60 ml/min，뇨단백정성양성（＋＋～＋＋＋＋）21례。채용COX비례풍험모형대환자예후진행생존분석，6조간생존곡선적비교사용Kaplan-Meier법，병용대수질화분석（ Log rank ststistic ）진행조간비교。결과다인소분석교정신고체중지수、흡연、년령、성별、고지혈증、고혈압、당뇨병、이전유무심기경사등위험인소후，발현PCI술후2년내，단백뇨여발생심장사건적상대위험도（ RR ）위1.772（95％ CI위1.163～2.699，P＝0.008）；A조여B조，D조여E조조간단백뇨여심장사건발생무통계학차이（ P＞0.05）；A조여C조조간단백뇨여발생심장사건적RR위4.117（95％CI위1.817～9.331，P＝0.001）；D조여F조조간단백뇨여발생심장사건적RR위5.471（95％CI위1.922～15.578，P＝0.001）；술후2년수방적생존곡선중，발현C조루계생존솔저우D조，F조루계생존솔명현저우A조화B、C、D、E조。6조환자적PCI술후생존솔적조간비교차이유통계학의의（χ2＝11.476，P＝0.043）。결론 eGFR연합뇨단백대관심병환자주예후평고경유효；대우감정화치료유심장사건고발생솔적관심병환자，연합eGFR화뇨단백정성불동수평진행술전평고，시일충간단유효적공구。
Objective To evaluate the values of the combined the Modification of Diet in Renal Disease ( MDRD) formula and qualitative classification of urine albumin on 2-year prognosis after Percutaneous Coronary Intervention(PCI).Methods One thousand two hundred and one PCI patients were divided into 6 groups by level of estimated glomerular filtration rate ( eGFR) and qualitative determination of urine albumine .We defined proteinuria as normal(urine dipstick negative),mild(urine dipstick trace or +),or heavy(urine dipstick≥++).A group:eGFR≥60 ml/min,urine albumin negative(n=659);B group eGFR≥60 ml/min,mild urine albumin(n=269);C group eGFR≥60 ml/min,heavy urine albumin(n=40);D group eGFR<60 ml/min,urine albumin negative(n=179),E group eGFR<60 ml/min,mild urine albumin(n=33),F group eGFR<60 ml/min,heavy urine albumin(n=21). The prognostic factors of PCI patients were analyzed by COX proportional hazards models .Kaplan-Meier survival analysis was used to compare survival curves between the six groups .The Log rank statistic was used to test for differences between groups.Results By multivariate COX regression,adjustment for body mass index,smoking, hypertension,hyperlipaemia, diabetes mellitus, previous MI, perioperative PCI and etc, the relative risk ( RR) of albuminuria for cardiac events was 1.772(95%CI:1.163-2.699,P=0.008).A group and B group,D group and E group had no statistical significance (P>0.05);The RR was 4.117(95%CI:1.817-9.331,P=0.001)for A group and C group;The RR between D group and F group was 5.471(95%CI:1.922-15.578,P=0.001);Among survival curve of 2 year follow-up after PCI,we concluded that the survival rate of C group was lower than that of D group ,and F group was lower than that of other groups ,the different survival rate among six groups had statistical significance (χ2 =11.476 ,P=0.043 ) .Conclusions The combination eGFR and proteinuria has a higher prognosis value in coronary heart disease patients ,eGFR and qualitative determination of urine albumine are simple and effect tools in evaluating cardiac events after hospitalization in coronary heart disease patients .