东南大学学报(医学版)
東南大學學報(醫學版)
동남대학학보(의학판)
JOURNAL OF SOUTHEAST UNIVERSITY(MEDICAL SCIENCE EDITION)
2014年
3期
267-271
,共5页
急性冠脉综合征%肾小球滤过率%严重心血管不良事件
急性冠脈綜閤徵%腎小毬濾過率%嚴重心血管不良事件
급성관맥종합정%신소구려과솔%엄중심혈관불량사건
acute coronary syndrome%estimated glomerular filtration rate%major adverse cardiovascular events
目的:探讨急性冠脉综合征患者的肾功能对远期预后的影响。方法:选取2010年1月至2011年12月在东南大学附属中大医院心脏科住院治疗的390例急性冠脉综合征患者,分为急性ST段抬高心肌梗死( n=171)和不稳定心绞痛/非 ST 段抬高心肌梗死( n =219)两组,每组根据肾小球滤过率( estimated glomerular filtration rate , eGFR)分为eGFR正常组[ eGFR≥90 ml· min-1·(1.73 m)-2]和eGFR降低组[ eGFR<90 ml· min -1·(1.73 m)-2]两个亚组。分析各亚组病变血管情况、临床生化指标、合并症以及治疗情况,并对所有患者进行12~36个月随访,观察各组远期严重心血管不良事件的发生情况。结果:急性ST段抬高心肌梗死患者中,eGFR正常患者108例,34例(31.5%)出现严重心血管不良事件;eGFR降低者63例,26例(41.3%)出现严重心血管不良事件,两亚组严重心血管不良事件发生率差异无统计学意义(风险比1.426,95%置信区间0.855~2.378,P=0.174)。12~36个月随访中两亚组严重心血管不良事件发生风险差异无统计学意义(P=0.065),但eGFR降低组患者的严重心血管不良事件发生率呈现明显的上升趋势。不稳定心绞痛/非ST段抬高心肌梗死患者中,eGFR正常者140例,41例(38.0%)发生严重心血管不良事件;eGFR降低者79例,18例(28.6%)出现严重心血管不良事件,两亚组严重心血管不良事件发生率差异无统计学意义(风险比0.836,95%置信区间0.480~1.455,P=0.526)。12~36个月随访两亚组严重心血管不良事件发生风险差异无统计学意义( P=0.522)。结论:肾功能不全的急性心肌梗死患者远期发生严重心血管不良事件的风险与肾功能正常患者相比有上升趋势,但尚无统计学意义。
目的:探討急性冠脈綜閤徵患者的腎功能對遠期預後的影響。方法:選取2010年1月至2011年12月在東南大學附屬中大醫院心髒科住院治療的390例急性冠脈綜閤徵患者,分為急性ST段抬高心肌梗死( n=171)和不穩定心絞痛/非 ST 段抬高心肌梗死( n =219)兩組,每組根據腎小毬濾過率( estimated glomerular filtration rate , eGFR)分為eGFR正常組[ eGFR≥90 ml· min-1·(1.73 m)-2]和eGFR降低組[ eGFR<90 ml· min -1·(1.73 m)-2]兩箇亞組。分析各亞組病變血管情況、臨床生化指標、閤併癥以及治療情況,併對所有患者進行12~36箇月隨訪,觀察各組遠期嚴重心血管不良事件的髮生情況。結果:急性ST段抬高心肌梗死患者中,eGFR正常患者108例,34例(31.5%)齣現嚴重心血管不良事件;eGFR降低者63例,26例(41.3%)齣現嚴重心血管不良事件,兩亞組嚴重心血管不良事件髮生率差異無統計學意義(風險比1.426,95%置信區間0.855~2.378,P=0.174)。12~36箇月隨訪中兩亞組嚴重心血管不良事件髮生風險差異無統計學意義(P=0.065),但eGFR降低組患者的嚴重心血管不良事件髮生率呈現明顯的上升趨勢。不穩定心絞痛/非ST段抬高心肌梗死患者中,eGFR正常者140例,41例(38.0%)髮生嚴重心血管不良事件;eGFR降低者79例,18例(28.6%)齣現嚴重心血管不良事件,兩亞組嚴重心血管不良事件髮生率差異無統計學意義(風險比0.836,95%置信區間0.480~1.455,P=0.526)。12~36箇月隨訪兩亞組嚴重心血管不良事件髮生風險差異無統計學意義( P=0.522)。結論:腎功能不全的急性心肌梗死患者遠期髮生嚴重心血管不良事件的風險與腎功能正常患者相比有上升趨勢,但尚無統計學意義。
목적:탐토급성관맥종합정환자적신공능대원기예후적영향。방법:선취2010년1월지2011년12월재동남대학부속중대의원심장과주원치료적390례급성관맥종합정환자,분위급성ST단태고심기경사( n=171)화불은정심교통/비 ST 단태고심기경사( n =219)량조,매조근거신소구려과솔( estimated glomerular filtration rate , eGFR)분위eGFR정상조[ eGFR≥90 ml· min-1·(1.73 m)-2]화eGFR강저조[ eGFR<90 ml· min -1·(1.73 m)-2]량개아조。분석각아조병변혈관정황、림상생화지표、합병증이급치료정황,병대소유환자진행12~36개월수방,관찰각조원기엄중심혈관불량사건적발생정황。결과:급성ST단태고심기경사환자중,eGFR정상환자108례,34례(31.5%)출현엄중심혈관불량사건;eGFR강저자63례,26례(41.3%)출현엄중심혈관불량사건,량아조엄중심혈관불량사건발생솔차이무통계학의의(풍험비1.426,95%치신구간0.855~2.378,P=0.174)。12~36개월수방중량아조엄중심혈관불량사건발생풍험차이무통계학의의(P=0.065),단eGFR강저조환자적엄중심혈관불량사건발생솔정현명현적상승추세。불은정심교통/비ST단태고심기경사환자중,eGFR정상자140례,41례(38.0%)발생엄중심혈관불량사건;eGFR강저자79례,18례(28.6%)출현엄중심혈관불량사건,량아조엄중심혈관불량사건발생솔차이무통계학의의(풍험비0.836,95%치신구간0.480~1.455,P=0.526)。12~36개월수방량아조엄중심혈관불량사건발생풍험차이무통계학의의( P=0.522)。결론:신공능불전적급성심기경사환자원기발생엄중심혈관불량사건적풍험여신공능정상환자상비유상승추세,단상무통계학의의。
Objective:To determine the long-term outcomes in acute coronary syndrome ( ACS) patients with or without chronic kidney disease (CKD).Methods:390 ACS patients who were treated in Zhongda Hospital from Jan, 2010 to Dec, 2011 were enrolled in the study .These patients were divided into two groups: ST elevated myocardial infarction(STEMI) group ( n =171) and non ST elevated myocardial infarction ( non-STEMI) group ( n=219 ) .Each group was divided into two subgroups according to the estimated glomerular filtration rate (eGFR):normal eGFR subgroup[eGFR≥90 ml· min -1· (1.73 m) -2] and low eGFR subgroup[eGFR<90 ml· min-1· (1.73 m) -2].Basic clinical characters were analyzed and major adverse cardiovascular events (MACEs) were observed during 12 ~36 months follow-up.Results: In STEMI group, 108 patients had normal renal function , MACEs happened in 34 patients ( 31 .5%) .63 patients had renal dysfunction , MACEs happened in 26 patients(41.3%) .The incidence of MACEs had no significant difference between two subgroups ( Hazard ratio 1.426, 95% confidence interval 0.855 -2.378, P=0.174).The cumulative hazard of MACEs between two subgroups had no significant difference ( P=0 .065 ) .However , increasing trend of MACEs incidence was observed in low eGFR subgroup .In non-STEMI group , 140 patients had normal renal function , MACEs happened in 41 patients(38.0%).79 patients had renal dysfunction , MACEs happened in 18 patients(28.6%).The incidence of MACEs had no significant difference between two subgroups ( Hazard ratio 0.836, 95% cofidence interval 0.480-1.455, P =0.526 ).The cumulative hazard of MACEs between two subgroups had no significant difference(P=0.522).Conclusion:STEMI patients with renal dysfunction have increased risk of MACEs in long term follow-up compared with normal renal function , although statistical significant was not detected .