急性冠脉综合征、肾动脉狭窄、急性左心衰三联征的临床研究  

Clinical observation of trilogy of acute coronary syndrome,renal artery stenosis and acute left heart failure

作　　者：任学文[1] 盖鲁粤[1] 王志国[1] 蒋博[1] 汪奇[1] 贾祥[1] 孙志军[1] 陈韵岱[1] 陈练[1] 白启才[1] 

机构地区：[1]解放军总医院心内科,北京100853

出　　处：《军医进修学院学报》2010年第5期427-429,共3页Academic Journal of Pla Postgraduate Medical School

基　　金："十一.五"国家科技支撑计划(2006BAI01A02)~~

摘　　要：目的提高对急性冠脉综合征、肾动脉狭窄、急性左心衰三联征的诊治率。方法回顾性分析25例急性冠脉综合征、肾动脉狭窄、急性左心衰三联征患者的临床资料,分析基线资料与预后的关系。结果高血压、陈旧性心梗、陈旧性脑梗、高脂血症、糖尿病、吸烟、周围血管病等危险因素的发生率分别为100%、54.0%、60.0%、40.0%、48.0%、36%;出现典型心绞痛症状至冠心病确诊(发生心梗/冠脉造影/冠脉CT确诊)平均为5.3年,冠心病确诊-肾动脉狭窄确诊约6.2年,心绞痛症状至肾动脉狭窄确诊约11.5年。造影结果13例为双侧肾动脉狭窄,平均冠脉病变为2.6支,确诊后所有患者进行了冠脉和(或)肾动脉介入或冠脉搭桥术。2例治疗无效死亡,其余23例好转出院,其中3例肾功能较入院时恶化。2年随访期内12例病情好转或稳定,4例死亡,7例发生次级终点事件;因小样本及选择偏倚,无基线资料与预后相关。结论三联征术后及两年预后较差,早期诊断、治疗才能减少发病率及改善预后。Objective To improve the diagnosis and treatment of trilogy of the acute coronary syndrome,renal artery stenosis and acute left heart failure.Methods Clinical data about 25 patients with the trilogy of the acute coronary syndrome,renal artery stenosis and acute left heart failure admitted to our hospital as well as the relation between baseline data and prognosis were retrospectively analyzed.Results The incidence of hypertension and old myocardial infarction,hyperlipidemia,diabetes mellitus,and peripheral angiopathy was 100%,54.0%,60.0%,40.0%,48.0%,and 36%,respectively,in the patients.The average period of time from the onset of angina pectoris to the final diagnosis of coronary heart disease（by angiography or computerized tomography or old MI） and renal artery stenosis（by angiography） was 5.3 years and 11.5 years respectively,while the average period of time for the verification of coronary heart disease and renal artery stenosis was 6.2 years.Thirteen patients were diagnosed with stenosis of bilateral renal artery and severe stenosis of 2.6 coronary arteries（area stenosis70%） in all patients.Coronary artery and/or renal artery intervention or coronary bypass was performed for all patients.Of the 25 patients,2 died due to the failure of treatment,23 were discharged from hospital after recovery.However,the renal function of 3 out of the 23 patients was worse at the time of discharge than at the time of admission.During the 2-year follow-up,12 patients were improved and their disease became stable,4 patients died,7 patients had secondary endpoint events.No baseline data were found to be related to the prognosis due to a small sample size and selection bias.Conclusion The prognosis of patients with trilogy of acute coronary syndrome,renal artery stenosis and acute left heart failure is poor 2 years after operation.Early diagnosis and treatment of the disease can decrease its incidence and improve its prognosis.

关 键 词：急性冠脉综合征 肾动脉梗阻 心力衰竭 收缩性 

分 类 号：R54[医药卫生—心血管疾病]