CAJ | 학술논문

目的探讨冠心病患者肾功能减退与冠状动脉病变严重程度的相关性。方法连续入选西京医院因冠心病行PCI术患者208例，记录术前空腹血糖、血脂四项、基础血肌酐、尿蛋白定量、血红蛋白、总蛋白、白蛋白、超敏C反应蛋白、脑钠肽（BNP）、左心室射血分数（LVEF）等值；根据Gensini积分系统将研究对象分为Gensini≤60组（冠状动脉轻度狭窄）、Gensini＞60组（冠状动脉中重度狭窄），进行临床资料的相关性研究。根据简化MDRD公式计算估计的肾小球滤过率（eGFR），eGFR≥60 ml· min-1·（1.73 m2）-1组为肾功能轻度减退，eGFR＜60 ml· min-1·（1.73 m2）-1组为肾功能中重度减退，并采用直线相关分析Gensini积分与eGFR的相关性。结果（1）Gensini≤60组和Gensini ＞60组相比在年龄（≥70岁）、性别、2型糖尿病、空腹血糖、HDL、血肌酐、基础心功能（ BNP、LVEF值≤45％）和eGFR等方面差异有统计学意义（ P＜0.05）。（2）eGFR＜60 ml· min-1·（1.73 m2）-1组和eGFR≥60 ml· min-1·（1.73 m2）-1组相比在年龄、性别、2型糖尿病、腰臀比、空腹血糖、HDL、血肌酐、Hs-CRP、白蛋白、基础心功能（ BNP、LVEF）和Gensini积分等方面差异有统计学意义（P＜0.05）。（3）eGFR＜60 ml· min-1·（1.73 m2）-1组和eGFR≥60 ml· min-1·（1.73 m2）-1组相比冠状动脉病变严重程度明显加重（Gensini＞60例数、冠状动脉病变支数及3支病变明显增多），差异有统计学意义（ P＜0.05）。（4） Gensini积分与eGFR之间呈负相关（ r＝-0.374， P＜0.001）。结论冠心病患者肾功能减退与冠状动脉病变严重程度具有相关性，在进行冠心病的治疗中需加强对肾功能减退的关注。
목적탐토관심병환자신공능감퇴여관상동맥병변엄중정도적상관성。방법련속입선서경의원인관심병행PCI술환자208례，기록술전공복혈당、혈지사항、기출혈기항、뇨단백정량、혈홍단백、총단백、백단백、초민C반응단백、뇌납태（BNP）、좌심실사혈분수（LVEF）등치；근거Gensini적분계통장연구대상분위Gensini≤60조（관상동맥경도협착）、Gensini＞60조（관상동맥중중도협착），진행림상자료적상관성연구。근거간화MDRD공식계산고계적신소구려과솔（eGFR），eGFR≥60 ml· min-1·（1.73 m2）-1조위신공능경도감퇴，eGFR＜60 ml· min-1·（1.73 m2）-1조위신공능중중도감퇴，병채용직선상관분석Gensini적분여eGFR적상관성。결과（1）Gensini≤60조화Gensini ＞60조상비재년령（≥70세）、성별、2형당뇨병、공복혈당、HDL、혈기항、기출심공능（ BNP、LVEF치≤45％）화eGFR등방면차이유통계학의의（ P＜0.05）。（2）eGFR＜60 ml· min-1·（1.73 m2）-1조화eGFR≥60 ml· min-1·（1.73 m2）-1조상비재년령、성별、2형당뇨병、요둔비、공복혈당、HDL、혈기항、Hs-CRP、백단백、기출심공능（ BNP、LVEF）화Gensini적분등방면차이유통계학의의（P＜0.05）。（3）eGFR＜60 ml· min-1·（1.73 m2）-1조화eGFR≥60 ml· min-1·（1.73 m2）-1조상비관상동맥병변엄중정도명현가중（Gensini＞60례수、관상동맥병변지수급3지병변명현증다），차이유통계학의의（ P＜0.05）。（4） Gensini적분여eGFR지간정부상관（ r＝-0.374， P＜0.001）。결론관심병환자신공능감퇴여관상동맥병변엄중정도구유상관성，재진행관심병적치료중수가강대신공능감퇴적관주。
Objective To explore the relationship between renal dysfunction and the severity of coronary artery lesion in patients with CHD .Methods A total of 208 patients were enrolled in this study .The individual information was collected from each patient ,and the levels of fasting blood glucose ,triglyceride,total cholesterol, HDL,LDL,base serum creatinine,24-hour urine protein,hemoglobin,serum total protein,albumin,hsCRP,BNP, LVEF were recorded before the treatment procedure .The severity of coronary artery lesion was accessed by the Gensini scoring system:Gensini≤60 group (mild coronary artery lesion),Gensini>60 group (moderate and severe coronary artery lesion ) .The glomerular filtration rate was calculated according to modification of diet in renal disease equation.The severity of renal dysfunction accessed by the eGFR:eGFR≥60 ml· min-1· (1.73 m2) -1 group(mild renal impairment) and eGFR<60 ml· min-1 · (1.73 m2 ) -1 group( moderate and severe renal dysfunction ),and then to compare between the eGFR and the Gensini scoring ( the severity of coronary artery disease ) .We also used linear corelation analysis to investigate the Gensini scoring with the eGFR in patients .Results ( 1 ) Age (≥70 years),sex,type 2 diabetes,fasting blood glucose,HDL,serum creatinine,basic cardiac function(LVEF≤45%, BNP) and eGFR showed statistical significance to between the different Gensini scoring groups (P<0.05).(2)Age, Sex,type 2 diabetes,Waist-to-hip ratio,fasting blood glucose,HDL,serum creatinine,hs-CRP,albumin,basic cardiac function(LVEF,BNP) and Gensini scoring showed statistical significance to between the different eGFR groups (P<0.05).(3)The severity of coronary artery lesion ( the patients of Gensini >60,3-vessel disease and the average vessel coronary artery disease ) showed statistical significance to between the eGFR <60 group and the eGFR≥60 group(P<0.05).(4)We also found the Gensini scoring had a negative correlation with the eGFR (r=-0.374,P<0.001 ) .Conclusions There was correlation between the renal dysfunction and the severity of coronary artery lesion in patients with CHD .It is suggested that patients with renal dysfunction should pay more attention to CHD treament .