摘要
目的:探讨冠心病(CAD)合并2型糖尿病(T2DM)患者远期出现肾功能下降的相关危险因素。方法:连续纳入我院CAD合并2DM患者共7 552例,收集患者的基线资料、实验室检查、用药史、冠状动脉造影及血运重建史,根据随访的肾小球滤过率(eGFR)值将患者分为肾功能保留组及肾功能下降组,应用COX比例风险模型分析肾功能下降的危险因素。结果:和对照组相比,肾功能下降组年龄较大,男性、高血压病史、高脂血症病史、血运重建史比例较高,入院时收缩压、心率较高,但已婚比例较低。化验检查结果:肾功能下降组比对照组有更高水平的TC、LDL-C、HCY、尿酸、总胆红素、红细胞压积,但白蛋白、HDL-C、HGB、RBC水平却低于对照组。用药史:肾功能下降组应用ACEI/ARB、皮下注射胰岛素及利尿剂比例高于对照组,口服降糖药及抗血小板药物用药比例低于对照组。以多因素COX比例风险回归模型对远期肾功能下降进行危险因素分析,提示男性、年龄、心率、高血压史、高脂血症病史、血同型半胱胺酸浓度、血尿酸浓度为T2DM合并CAD患者远期肾功能下降的危险因素。结论:男性、年龄、心率、高血压史、高脂血症病史、血同型半胱胺酸浓度、血尿酸浓度为T2DM合并CAD患者远期肾功能下降之危险因素。
Objective: To explore the risk factors for renal function decline in patients with coronary artery disease(CAD)and type 2 diabetes mellitus(T2 DM). Methods: A total of 7 552 patients with both CAD and T2 DM from Beijing Anzhen hospital were enrolled in this study. Patient’s data which include baseline data, laboratory findings, past medical history, coronary angiography and operation history were collected. We divided patients into renal function maintain group and renal function decline group according to follow-up estimated glomerular filtration rate(eGFR)data. Analyzed risk factors for renal function decline with COX regression model. Results: Compared with the control group, the renal function decline group was older and has a higher proportion of male gender, history of hypertension, hyperlipidemia and revascularization, higher levels of systolic blood pressure and heart rate, but a lower proportion of being married. Laboratory findings: The renal function decline group had higher levels of TC, LDL-C, HCY, UA, total bilirubin and hematocrit, lower levels of albumin, HDL-C, hemoglobin and red blood cell than the control group. Medical history: The proportion of usage of ACEI/ARB, subcutaneous injection of insulin and diuretic was higher in the renal function decline group than in the control group. Conversely, the proportion of usage of oral hypoglycemic agents and antiplatelet drugs was lower in the renal function decline group. Multivariate COX regression model was used to analyze the risk factors for renal function decline, suggesting that male gender, age, heart rate, history of hypertension, history of hyperlipidemia, blood homocysteine concentration and serum uric acid concentration were independent risk factors for renal function decline in patients with CAD and T2 DM. Conclusions: Male gender, age, heart rate, history of hypertension, history of hyperlipidemia, blood homocysteine concentration and serum uric acid concentration were independent risk factors for renal function decline in patients with
作者
张敬林
周玉杰
王悦
彭丁
马越
王德广
刘妍
傅明洁
CHANG Chinglin;ZHOU Yujie;WANG Yue;PENG Ding;MA Yue;WANG Deguang;LIU Yan;FU Mingjie(Department of 12th Ward,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)
出处
《心肺血管病杂志》
2019年第2期128-132,共5页
Journal of Cardiovascular and Pulmonary Diseases
基金
国家重点研发计划"精准医学研究"重点专项(2017YFC0908800)
北京市医院管理局"登峰"计划专项经费资助(DFL20150601)
北京市医院管理局"使命"计划专项经费资助(SML20180601)
北京市医院管理局临床医学发展专项经费资助(ZYLX201303
XMLX201601)
关键词
冠心病
2型糖尿病
肾功能下降
Coronary artery disease
Type 2 diabetes mellitus
Renal function decline
