CAJ | 학술논문

目的：探讨和分析可能影响冠状动脉介入术后1年的急性冠状动脉综合征（acute coronary syndrome，ACS）患者肾功能的因素及其作用。方法回顾了2013年1月至2013年9月以ACS诊断并收治于首都医科大学宣武医院心脏科并行冠状动脉介入治疗的287例患者的发病情况、临床资料及随访1年的资料。按照估算的肾小球滤过率（estimated glomerular filtration rate， eGFR）的变化情况将研究人群分为eGFR下降组（n＝155）和eGFR维持组（n＝132），应用Logistic多因素分析明确对患者肾功能产生影响的因素及作用。结果 eGFR下降组中高血压患者更多（67.4％ vs 55.5％），非ST段抬高的急性冠状动脉综合征的患者比例更高（58.3％ vs 42.6％）；两组患者在入院血红蛋白含量[（140.4±17.6）g／L vs [（140.2±14.3）g／L]，差异有统计学意义（F＝5.384，P＝0.020），在年龄、性别比例、糖尿病史、脑梗死病史、血脂、血糖、心肌酶、左心室射血分数、造影剂用量、冠状动脉病变血管支数以及支架置入数目方面比较，差异无统计学意义（P＞0.05）。Logistic分析结果表明，高血压病史以及急性冠状动脉综合征不同分型对于eGFR的下降具有独立的影响作用（P＝0.010，OR＝1.949，95％CI：1.174～3.237；P＝0.004，OR＝2.08，95％CI：1.265～3.418）。结论在接受了冠状动脉介入治疗的ACS患者中，具有高血压病史和非ST段抬高型急性冠状动脉综合征的患者在术后1年随访中发现eGFR降低的风险较高。
목적：탐토화분석가능영향관상동맥개입술후1년적급성관상동맥종합정（acute coronary syndrome，ACS）환자신공능적인소급기작용。방법회고료2013년1월지2013년9월이ACS진단병수치우수도의과대학선무의원심장과병행관상동맥개입치료적287례환자적발병정황、림상자료급수방1년적자료。안조고산적신소구려과솔（estimated glomerular filtration rate， eGFR）적변화정황장연구인군분위eGFR하강조（n＝155）화eGFR유지조（n＝132），응용Logistic다인소분석명학대환자신공능산생영향적인소급작용。결과 eGFR하강조중고혈압환자경다（67.4％ vs 55.5％），비ST단태고적급성관상동맥종합정적환자비례경고（58.3％ vs 42.6％）；량조환자재입원혈홍단백함량[（140.4±17.6）g／L vs [（140.2±14.3）g／L]，차이유통계학의의（F＝5.384，P＝0.020），재년령、성별비례、당뇨병사、뇌경사병사、혈지、혈당、심기매、좌심실사혈분수、조영제용량、관상동맥병변혈관지수이급지가치입수목방면비교，차이무통계학의의（P＞0.05）。Logistic분석결과표명，고혈압병사이급급성관상동맥종합정불동분형대우eGFR적하강구유독립적영향작용（P＝0.010，OR＝1.949，95％CI：1.174～3.237；P＝0.004，OR＝2.08，95％CI：1.265～3.418）。결론재접수료관상동맥개입치료적ACS환자중，구유고혈압병사화비ST단태고형급성관상동맥종합정적환자재술후1년수방중발현eGFR강저적풍험교고。
Objective To investigate the effect of possible influential factors on renal function among patients 1 year after coronary interventions.Methods Totally 287 patients with acute coronary syndrome (ACS)seen from Jan.201 3 to Sep.201 3 were enrolled in this retrospective study.All of them were treated with percutaneous coronary intervention (PCI)and followed up for at least 1 year.Then the clinical data were collected and analyzed retrospectively.The patients were divided into two groups according to the estimated glomerular filtration rate (eGFR)decreased or maintained after 1 year follow-up and a Logistic regression analysis was used to analyze the effect of influential factors.Results Compared with eGFR maintained group (n=1 32),hypertension (HTN)(67.4%vs 55.5%)and non-ST segment elevation ACS (NSTEACS)(58.3%vs 42.6%)were much common in eGFR decreased group (n=1 55)(P=0.02). There was a statistical significant difference in hemoglobin (HGB)(1 40.4 ±1 7.6g/L vs 1 40.2 ±1 4.3g/L;F=5.384,P=0.02)but no significant difference in age,gender,diabetes mellitus (DM),ischemic stroke (IS)history,cholesterol,glucose,myocardial enzymes, left ventricular ejection fraction (LVEF),dosage of contrast media,number of vessels with stenosis and number of stents implanted in one patient (P>0.05 )between the two groups.The Logistic analysis indicated that HTN and NSTEACS were independent risk factors to influence the eGFR (P=0.01 ,OR=1.949,95% CI:1.1 74-3.237 and P=0.004,OR=2.08,95%CI:1.265 -3.41 8).Conclusion For ACS patients who received PCI,those who had hypertension and NSTEACS were more likely to have decreased eGFR after 1 yearfollowup.