CAJ | 학술논문

目的分析轻度肾功能不全对急性冠状动脉综合征患者(ACS)终点事件的预测价值.方法按估算的肾小球滤过率(eGFR)水平不同,将552例ACS患者分为肾功能正常组(eGFR≥90ml·min-1·1.73 m-2)与轻度肾功能不全组(eGFR60～＜90 ml·min-1·1.73 m-2),前瞻性随访并分析轻度肾功能不全与ACS患者终点事件的相关性.结果轻度肾功能不全组患者初级终点事件的发生率高于肾功能正常组[31例(12.6％)比15例(4.9％),P=0.001],次级终点事件的发生在两组间差异无统计学意义.初级终点事件中全因死亡[22例(8.9％)比7例(2.2％),P＜0.001]及心源性死亡[16例(6.5％)比4例(1.3％),P=0.001]的发生率在轻度肾功能不全组较高,而非致死性卒中及心肌梗死的发生两组间差异无统计学意义.COX回归模型分析结果发现,轻度肾功能不全患者发生初级终点事件的相对危险度是肾功能正常患者的2.265倍(95％ CI1.076 ～4.771,P=0.031),对各单独事件进一步分析表明轻度肾功能不全对全因死亡有预测价值(HR3.118,95％ CI1.197～8.125,P=0.020).初级终点事件及全因死亡的Kaplan-Meier曲线显示,轻度肾功能不全组患者的初级终点事件(p=0.004)及全因死亡(P=0.001)的发生率高于肾功能正常组.结论轻度肾功能不全对ACS患者的初级终点事件具有重要预测价值.
목적 분석경도신공능불전대급성관상동맥종합정환자(ACS)종점사건적예측개치.방법 안고산적신소구려과솔(eGFR)수평불동,장552례ACS환자분위신공능정상조(eGFR≥90ml·min-1·1.73 m-2)여경도신공능불전조(eGFR60～＜90 ml·min-1·1.73 m-2),전첨성수방병분석경도신공능불전여ACS환자종점사건적상관성.결과 경도신공능불전조환자초급종점사건적발생솔고우신공능정상조[31례(12.6％)비15례(4.9％),P=0.001],차급종점사건적발생재량조간차이무통계학의의.초급종점사건중전인사망[22례(8.9％)비7례(2.2％),P＜0.001]급심원성사망[16례(6.5％)비4례(1.3％),P=0.001]적발생솔재경도신공능불전조교고,이비치사성졸중급심기경사적발생량조간차이무통계학의의.COX회귀모형분석결과발현,경도신공능불전환자발생초급종점사건적상대위험도시신공능정상환자적2.265배(95％ CI1.076 ～4.771,P=0.031),대각단독사건진일보분석표명경도신공능불전대전인사망유예측개치(HR3.118,95％ CI1.197～8.125,P=0.020).초급종점사건급전인사망적Kaplan-Meier곡선현시,경도신공능불전조환자적초급종점사건(p=0.004)급전인사망(P=0.001)적발생솔고우신공능정상조.결론 경도신공능불전대ACS환자적초급종점사건구유중요예측개치.
Objective To investigate the predictive value of mild renal insufficiency on the endpoint events in patients with acute coronary syndrome (ACS).Methods A total of 552 patients with ACS were enrolled in the present study.According to the levels of estimated glomerular filtration rate (eGFR),patients were divided into two groups,normal renal function (eGFR≥90 ml · min-1 · 1.73 m-2) and mild renal insufficiency (60≤eGFR ＜90 ml · min-1 · 1.73 m-2).The primary and secondary events were collected and analyzed through the present prospective follow-up study.Results The patients in mild renal insufficiency group had a higher incidence of the primary endpoint events than normal renal function group [31 cases (12.6％) vs 15 cases (4.9％),P =0.001].There was no difference of the secondary endpoint events incidence in the two groups.The incidence rate of all-cause mortality [8.9％ (22 cases) vs 2.2％ (7 cases),P ＜0.001] and cardiac death [6.5％ (16 cases) vs 1.3％ (4 cases),P =0.001] was higher in mild renal insufficiency group,but there was no statistical difference of incidence rate of no fatal stroke and myocardial infarction in the two groups.The results of COX regression analysis showed that the incidence of primary endpoint events in patients with mild renal dysfunction was 2.265 folds (95％ CI 1.076-4.771,P=0.031) of patients with normal renal function.Further analysis indicated that the predictive value of mild renal insufficiency was only for all-cause mortality (HR 3.118,95％ CI 1.197-8.125,P =0.020),not for heart failure and revascularization.According to the Kaplan-Meier curves results,the incidences of the primary endpoint events (P =0.004) and all-cause mortality (P =0.001) were higher in mild renal insufficiency group than in normal renal function group.Conclusion Mild renal insufficiency has important predictive value for primary endpoint events in patients with ACS.