中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2015年
10期
848-853
,共6页
冠状动脉疾病%肾疾病%血管成形术,经腔,经皮冠状动脉
冠狀動脈疾病%腎疾病%血管成形術,經腔,經皮冠狀動脈
관상동맥질병%신질병%혈관성형술,경강,경피관상동맥
Coronary disease%Kidney diseases%Angioplasty,transluminal,percutaneous coronary
目的 探讨经皮冠状动脉介入治疗(PCI)在急性冠状动脉综合征(ACS)合并慢性肾脏病患者中应用的安全性.方法 回顾性分析2011年1月至2014年5月在北京朝阳医院治疗的335例ACS合并慢性肾脏病患者的临床资料.根据住院期间是否接受PCI,将患者分为PCI组(n=135)和保守治疗组(n=200).采用多因素logistic回归分析PCI与患者院内病死率及院内肾功能恶化率的关系.结果 335例患者的肾小球滤过率(GFR)中位数为36.26(25.09 ～47.65)ml· min-1·1.73 m-2.PCI组与保守治疗组患者的GFR差异无统计学意义(P =0.205).多因素logistic回归分析显示,PCI组与保守治疗组相比院内病死率(OR=0.465,95％CI:0.190 ～1.136,P=0.093)和院内肾功能恶化率(OR =0.830,95％ CI:0.375～1.836,P=0.669)差异均无统计学意义;在45 ml·min-1·1.73 m-2≤GFR ＜60 ml·min-1·1.73 m-2、30 ml·min-1· 1.73 m-2≤GFR ＜45 ml·min-1· 1.73 m-2和GFR ＜30 ml·min-1·1.73 m-2的患者中,PCI组与保守治疗组相比院内病死率差异无统计学意义[OR值分别为0.235(95％CI:0.024 ～2.301,P=0.213)、0.640(95％ CI:0.112 ～3.649,P=0.616)和0.919(95％CI:0.159 ～ 5.307,P=0.925)],院内肾功能恶化率差异也无统计学意义[OR值分别为0.436(95％ CI:0.120 ～1.587,P=0.208)、2.209 (95％ CI:0.394 ～ 12.391,P=0.368)和0.724(95％CI:0.127 ～4.117,P=0.716)].结论 对于合并慢性肾脏病的ACS患者,PCI不增加其院内死亡及肾功能恶化的风险.
目的 探討經皮冠狀動脈介入治療(PCI)在急性冠狀動脈綜閤徵(ACS)閤併慢性腎髒病患者中應用的安全性.方法 迴顧性分析2011年1月至2014年5月在北京朝暘醫院治療的335例ACS閤併慢性腎髒病患者的臨床資料.根據住院期間是否接受PCI,將患者分為PCI組(n=135)和保守治療組(n=200).採用多因素logistic迴歸分析PCI與患者院內病死率及院內腎功能噁化率的關繫.結果 335例患者的腎小毬濾過率(GFR)中位數為36.26(25.09 ～47.65)ml· min-1·1.73 m-2.PCI組與保守治療組患者的GFR差異無統計學意義(P =0.205).多因素logistic迴歸分析顯示,PCI組與保守治療組相比院內病死率(OR=0.465,95％CI:0.190 ～1.136,P=0.093)和院內腎功能噁化率(OR =0.830,95％ CI:0.375～1.836,P=0.669)差異均無統計學意義;在45 ml·min-1·1.73 m-2≤GFR ＜60 ml·min-1·1.73 m-2、30 ml·min-1· 1.73 m-2≤GFR ＜45 ml·min-1· 1.73 m-2和GFR ＜30 ml·min-1·1.73 m-2的患者中,PCI組與保守治療組相比院內病死率差異無統計學意義[OR值分彆為0.235(95％CI:0.024 ～2.301,P=0.213)、0.640(95％ CI:0.112 ～3.649,P=0.616)和0.919(95％CI:0.159 ～ 5.307,P=0.925)],院內腎功能噁化率差異也無統計學意義[OR值分彆為0.436(95％ CI:0.120 ～1.587,P=0.208)、2.209 (95％ CI:0.394 ～ 12.391,P=0.368)和0.724(95％CI:0.127 ～4.117,P=0.716)].結論 對于閤併慢性腎髒病的ACS患者,PCI不增加其院內死亡及腎功能噁化的風險.
목적 탐토경피관상동맥개입치료(PCI)재급성관상동맥종합정(ACS)합병만성신장병환자중응용적안전성.방법 회고성분석2011년1월지2014년5월재북경조양의원치료적335례ACS합병만성신장병환자적림상자료.근거주원기간시부접수PCI,장환자분위PCI조(n=135)화보수치료조(n=200).채용다인소logistic회귀분석PCI여환자원내병사솔급원내신공능악화솔적관계.결과 335례환자적신소구려과솔(GFR)중위수위36.26(25.09 ～47.65)ml· min-1·1.73 m-2.PCI조여보수치료조환자적GFR차이무통계학의의(P =0.205).다인소logistic회귀분석현시,PCI조여보수치료조상비원내병사솔(OR=0.465,95％CI:0.190 ～1.136,P=0.093)화원내신공능악화솔(OR =0.830,95％ CI:0.375～1.836,P=0.669)차이균무통계학의의;재45 ml·min-1·1.73 m-2≤GFR ＜60 ml·min-1·1.73 m-2、30 ml·min-1· 1.73 m-2≤GFR ＜45 ml·min-1· 1.73 m-2화GFR ＜30 ml·min-1·1.73 m-2적환자중,PCI조여보수치료조상비원내병사솔차이무통계학의의[OR치분별위0.235(95％CI:0.024 ～2.301,P=0.213)、0.640(95％ CI:0.112 ～3.649,P=0.616)화0.919(95％CI:0.159 ～ 5.307,P=0.925)],원내신공능악화솔차이야무통계학의의[OR치분별위0.436(95％ CI:0.120 ～1.587,P=0.208)、2.209 (95％ CI:0.394 ～ 12.391,P=0.368)화0.724(95％CI:0.127 ～4.117,P=0.716)].결론 대우합병만성신장병적ACS환자,PCI불증가기원내사망급신공능악화적풍험.
Objective To evaluate the safety of percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS) complicating chronic kidney disease (CKD).Methods We retrospectively evaluated the medical data of 335 patients hospitalized in our hospital with a diagnosis of ACS and CKD between 1 January 2011 and 30 May 2014.Patients were divided into two groups: PCI group who received PCI treatment during hospitalization (n =135) and non-PCI group who did not receive PCI treatment (n =200).Multivariable logistic regression analysis was performed to evaluate the connection between PCI and in-hospital death and acute renal insufficiency.Results The median GFR level of 335 patients was 36.26 (25.09-47.65) ml · min-1 · 1.73 m-2.GFR level was similar between the two groups (P =0.205).Multivariable logistic regression analysis showed that PCI did not increase the risk of inhospital death (OR =0.465,95％ CI:0.190-1.136, P =0.093) and in-hospital acute renal insufficiency (OR =0.830,95％ CI:0.375-1.836, P =0.669).In patients of 45 ml · min-1 · 1.73 m-2 ≤ GFR ＜ 60 ml · min-1 · 1.73 m-2, 30 ml · min-1 · 1.73 m-2≤GFR ＜45 ml · min-1 · 1.73 m-2 and GFR ＜30 ml · min-1 · 1.73 m-2, the OR of in-hospital death in PCI group were 0.235 (95％ CI:0.024-2.301 ,P =0.213), 0.640(95％ CI:0.112-3.649,P =0.616)and 0.919(95％ CI:0.159-5.307,P =0.925) ,and the OR of in-hospital acute renal insufficiency were 0.436 (95％ CI: 0.120-1.587, P =0.208), 2.209 (95 ％ CI: 0.394-12.391, P =0.368) and 0.724 (95 ％ CI: 0.127-4.117, P =0.716) indicating that PCI did not increase above events in ACS patients complicating CKD.Conclusion PCI does not increase the risk of in-hospital death and in-hospital acute renal insufficiency in ACS patients complicating CKD.
