摘要
目的分析不稳定型心绞痛(unstable angina pectoris,UAP)合并慢性肾功能不全患者血栓弹力图检测结果。方法行经皮冠状动脉介入治疗的不稳定型心绞痛患者552例,根据肾小球滤过率估计值(estimated glomerular filtration rate,eGFR)水平分为肾功能不全组264例[eGFR<90mL/(min·1.73m2)]和肾功能正常组288例[eGRF≥90mL/(min·1.73m2)]。检测并比较2组血栓弹力图各指标之间的差异。结果肾功能不全组年龄、体质量、有吸烟史、合并高血压、糖尿病比例及高敏C反应蛋白、血肌酐水平高于正常肾功能组,高密度脂蛋白胆固醇和血红蛋白水平低于肾功能正常组(P<0.05);肾功能不全组冠状动脉单支病变比例(30.3%)低于肾功能正常组(48.6%),SYNTAX积分(23.9±8.3)高于肾功能正常组(18.2±7.0)(P<0.05);肾功能不全组反应时间(R值)[(5.09±1.02)min]、血凝块动力(K值)[(1.40±0.20)min]和二磷酸腺苷抑制率[(55.21±15.16)%]低于肾功能正常组[(5.58±0.76)min、(1.64±0.42)min、(64.52±17.32)%](P<0.05);血凝块强度(MA值)[(56.42±10.23)mm]、血凝块形成的速率(α角)[(66.68±10.92)°]高于肾功能正常组[(48.08±9.75)mm、(57.46±11.43)°](P<0.05);多因素回归分析显示,在控制年龄、体质量、吸烟、高血压等影响因素后,eGRF水平是二磷酸腺苷抑制率的独立影响因素(β=0.875,P=0.000)。结论合并慢性肾功能不全的UAP患者血液呈高凝状态,经皮冠状动脉介入术后需个体化抗血小板治疗以减少心血管事件。
Objective To analyze the thromboelastography results in unstable angina pectoris(UAP)patients with chronic renal insufficiency.Methods According to the estimated glomerular filtration rate(eGFR)value,552 patients with UAP undergoing percutaneous coronary intervention(PCI)were divided into renal insufficiency group(eGFR<90mL/(min·1.73m2),n=264)and normal renal function group(eGFR<90 mL/(min·1.73 m2),n=288).The differences in the indexes of thromboelastography were detected and compared between two groups.Results The age,body mass,smoking history,rates of complication of hypertension and diabetes mellitus,high sensitivity C-reactive protein and serum creatinine were significantly higher,while the levels of high density lipoprotein-cholesterol and hemoglobin were significantly lower in renal insufficiency group than those in normal renal function group(P<0.05).The proportion of single vessel lesion was 30.3% in renal insufficiency group,significantly lower than that in normal renal function group(48.6%),while the SYNTAX score was significantly higher in renal insufficiency group(23.9±8.3)than that in normal renal function group(18.2±7.0)(P<0.05).The values of R and K((5.09±1.02),(1.40±0.20)min)and adenosine diphosphate inhibition rate((55.21±15.16)%)in renal insufficiency group were significantly lower than those in normal renal function group((5.58±0.76)min,(1.64±0.42)min,(64.52±17.32)%)(P<0.05).M value((56.42±10.23)mm)was significantly higher andαangle((66.68±10.92)°)was significantly larger in renal insufficiency group than those in normal renal function group((48.08±9.75)mm,(57.46±11.43)°)(P<0.05).Multivariate regression analysis showed that eGRF level was the independent influencing factor for adenosine diphosphate inhibition rate after controlling the age,body mass,smoking,hypertension and other general data(β=0.875,P= 0.000).Conclusion Hypercoagulation may exist in UAP patients with chronic renal insufficiency,suggesting the need for individualized antiplatelet therapy after PCI to reduce th
出处
《中华实用诊断与治疗杂志》
2017年第2期135-138,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
国家自然科学基金面上项目(81670337)
首都临床特色应用研究项目(Z13110700223042)
北京市医管局人才培养青苗计划项目(QML20150602)
关键词
不稳定型心绞痛
慢性肾功能不全
血栓弹力图
二磷酸腺苷抑制率
Unstable angina pectoris
chronic renal insufficiency
thromboelastography
adenosine diphosphate inhibition rate
