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急性冠脉综合征合并肾功能不全患者远期预后研究
作者:余超君1  陈忠2  马根山1 
单位:1. 东南大学附属中大医院 心血管内科, 江苏 南京 210009;
2. 上海市第六人民医院 心血管内科, 上海 200120
关键词:急性冠脉综合征 肾小球滤过率 严重心血管不良事件 
分类号:R543.3;R692.5
出版年·卷·期(页码):2014·33·第三期(267-271)
摘要:

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。

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.

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