摘要
目的探讨肾功能与冠状动脉病变严重程度及急性冠状动脉综合征（ACS）之间的关系。方法收集2010年1月至2010年10月因怀疑冠心病至山西医科大学第二医院行冠状动脉造影的344例住院患者,男性237例,其中不稳定型心绞痛（UA）组165例,急性心肌梗死（AMI）组93例,冠状动脉造影阴性设为对照组,共86例。以酶法测定血脂[总胆固醇（TC）,低密度脂蛋白胆固醇（LDLC）,高密度脂蛋白胆固醇（HDLC）],使用免疫透射比浊法测定Lp（a）,以苦味酸法测定血浆肌酐（Scr）;e GFR计算方法：a MDRD公式;根据改良Gensini积分对冠状动脉病变程度积分。结果 （1）对照组,UA组与AMI组Scr值分别为64.32±10.53μmol/L,70.54±13.42μmol/L及85.47±13.52μmol/L,对照组低于AMI组（P〈0.05）;三组e GFR值分别为113.52±17.47 m L/（min·1.73 m2）,88.54±14.53 m L/（min·1.73 m2）与80.53±13.63 m L/（min·1.73 m2）（P值均〈0.05）;UA组与AMI组Gensini评分为40.54±23.45分与54.78±23.78分（P值〈0.05）。（2）e GFR与Gensini评分呈负相关关系（r=-0.507）,LDLC（r=0.865）、TC（r=0.743）、Lp（a）（r=0.221）与Gensini评分呈正相关关系（P〈0.001）。（3）通过将TC、TG、LDLC、HDLC、Lp（a）、Scr、e GFR七项进行多因素Logistic回归分析,e GFR（OR=0.249,95%CI为0.132~0.472,P〈0.001）与LDLC（OR=15.724,95%CI为8.042~30.732,P〈0.001）及TC（OR=7.402,95%CI为4.534~12.083,P〈0.001）一同进入方程。（4）PCI术患者随访结果：随访时间、全因死亡率、MACE、阿司匹林及氯吡格雷服药时间、因心绞痛再住院率等差异均无统计学意义（P〉0.05）.结论急性冠状动脉综合症与肾功能之间存在联系,肾功能越差急性冠状动脉综合征患者冠状动脉病变越严重。慢性肾功能不全是急性冠状动脉综合症诊断的独立危险因素。本研究尚未观察到肾功能损害影响PCI术患者的短期预后。
Aim To investigate correlation between renal function and severity of coronary lesions and ACS.Methods A total of 344 patients treated in the Second Hospital of Shanxi Medical University who were diagnosed by coronary angiography were studied. The patients were divided into 3 groups： Unstable Angina（ UA） group,n = 165; Acute Myocardial Infarction（ AMI） group,n = 93 and control group of the patients with CAG showing no evidence of coronary artery disease,n = 86. Total cholesterol（ TC）,low density lipoprotein cholesterol（ LDLC）,high denslity lipoprotein cholesterol（ HDLC） were measured by enzymic method and lipoprotein a by immune turbidity method; Serum creatinine by picric acid method; The calculation method of e GFR was the a MDRD formula; The method of evaluating the severity of coronary lesions was the modified Gensini. Results（ 1） The Scr of Control group,UA group and AMI group were（ 64. 32± 10. 53） μmol / L,70. 54 ± 13. 42 μmol / L and 85. 47 ± 13. 52 μmol / L（ the Control vs AMI group,P 〈0. 05）; The e GFR[m L/（ min·1. 73 m2） ]of Control group,UA group and AMI group were 113. 52 ± 17. 47 m L/（ min·1. 73 m2）,88. 54± 14. 53 m L /（ min·1. 73 m2） and 80. 53 ± 13. 63 m L/（ min·1. 73 m2）（ all P 0. 05）; The Gensini scores of the UA group and AMI group were 40. 54 ± 23. 45 and 54. 78 ± 23. 78（ P〈 0. 05）.（ 2） There was a negative corelation between e GFR and Gensini scores（ r =- 0. 507）; LDLC（ r = 0. 865）,TC（ r = 0. 743） and Lp（ a）（ r = 0. 221） were positively correlated with Gensini scores（ all P 〈0. 001）.（ 3） Multivariate logistic regression analysis（ forward method） indicated that e GFR（ OR = 0. 249,95% CI 0. 132 ~ 0. 472,P〈 0. 001）,LDLC（ OR = 15. 724,95% CI 8. 042 ~ 30. 732,P〈 0. 001） and TC（ OR = 7. 402,95% CI 4. 534 ~ 12. 083,P〈 0. 001） were interrelated with ACS.（ 4） Results of follow up： there was no statistical difference in follow up time,mortality,MACE,tking time of asp
出处
《中国动脉硬化杂志》
CAS
北大核心
2015年第9期937-941,共5页
Chinese Journal of Arteriosclerosis
