三种不同肾功能评估方法对冠状动脉旁路移植术后死亡的预测  

Value of estimated glomerular filtration rate and serum creatinine for predicting long-term survival in Chinese patients after isolated coronary artery bypass graft surgery

作　　者：林野[1] 郑哲[1] 胡盛寿[1] 许建屏[1] 吕锋[1] 王巍[1] 宋云虎[1] 孙寒松[1] 袁昕[1] 潘湘斌[1] 

机构地区：[1]中国医学科学院北京协和医学院 心血管病研究所 阜外心血管病医院外科,100037

出　　处：《中华心血管病杂志》2010年第2期99-102,共4页Chinese Journal of Cardiology

基　　金：十一五国家科技支撑计划（2006BAI01A09）

摘　　要：目的比较三种不同肾功能评估方法对冠状动脉旁路移植术后死亡的预测作用。方法回顾分析1999年1月至2005年12月收治的5559例冠状动脉旁路移植术患者的资料。以患者术前72h内空腹血清肌酐值、Cockcroft—Gault公式和简化MDRD公式计算的估测肾小球滤过率作为肾功能的评估方法。通过受试者工作特征（ROC）曲线、Cox比例风险回归分析，比较三种不同肾功能评估方法对冠状动脉旁路移植术后死亡的预测作用。结果ROC曲线分析显示，Cockcroft—Gauh公式预测住院死亡的准确性最高（ROC曲线下面积：0．755，P〈0．01）。Cox比例风险回归分析显示：Cockcroft-Gault公式估测肾小球滤过率对住院死亡的预测作用最高[相对危险度（HR）：4．51，P〈0．01]，优于简化MDRD公式估测肾小球滤过率（HR：3．43，P〈0．01）和血清肌酐（HR：2．86，P〈0．01）；Cockcroft—Gault公式估测肾小球滤过率（HR：1．54，P〈0．01）和简化MDRD公式估测肾小球滤过率（HR：1．60，P〈0．01）对远期死亡的预测作用均优于血清肌酐（HR：1．40，P=0．11）。结论术前肾功能不全是冠状动脉旁路移植术后死亡的独立危险因素。Cockcroft-Gault公式估测肾小球滤过率对住院死亡的预测作用优于简化MDRD公式估测肾小球滤过率和血清肌酐，Cockcroft-Gault公式估测肾小球滤过率和简化MDRD公式估测肾小球滤过率对远期死亡的预测作用均优于血清肌酐。Objective To compare the predictive value of glomerular filtration rate （GFR） estimated by the Cockcroft-Gault formula or the modification of diet in renal disease （MDRD） equation and serum creatinine for in-hospital and long-term mortality post coronary artery bypass graft surgery （CABG）. Methods Clinical data of 5559 consecutive patients undergoing isolated CABG were retrospectively analyzed. The main outcomes were in-hospital mortality and long-term mortality. Estimated GFR was calculated by the Cockcroft-Ganh formula and MDRD equation respectively. Receiver-operating characteristic curves and Cox＇s analysis were used for the comparison. Results Follow-up was complete in 5485 patients （97.6%）. Analysis of receiver-operating characteristic curves showed that GFR estimated by the Cockcroft- Ganh formula had a maximal accuracy for predicting in-hospital mortality （area under the curve ：0. 755, P 〈 0. 01 ）. Multivariate logistic analysis and the Cox＇s analysis results indicated estimated GFR 〈 60 ml · min^-1 · 1.73 m^-2 base on the Cockcroft-Ganh formula was an independent risk factor for in-hospital and long-term mortality （ hazard ratio 4. 51 for in-hospital mortality, P 〈 O. 01 ; hazard ratio 1.54 for long-term mortality, P 〈0. 01 ）, both Cockcroft-Gauh formula and MDRD equation were superior to serum creatinine for predicting in-hospital and long-term mortality post CABG. Conclusion GFR estimated by the Cockcroft- Gault formula was superior to GFR estimated by the MDRD equation for predicting in-hospital mortality, and estimated GFR was superior to serum ereatinine for predicting in-hospital and long-term mortality.

关 键 词：冠状动脉分流术 肾功能不全 肾小球滤过率 

分 类 号：R654.2[医药卫生—外科学]