肾功能不全患者置入药物洗脱支架及其对支架血栓的影响  

Drug eluting stents in renal functional insufficiency patients and its influence on stent thrombosis.

作　　者：张强[1] 马长生[1] 聂绍平[1] 吕强[1] 康俊萍[1] 杜昕[1] 胡荣[1] 刘新民[1] 刘小慧[1] 吴学思[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科,100029

出　　处：《中国综合临床》2010年第12期1260-1264,共5页Clinical Medicine of China

基　　金：国家重点基础研究发展规划资金资助项目（973计划）（2003CB517103）

摘　　要：目的 了解药物洗脱支架（DES）在肾功能不全患者中的使用状况及其安全性和有效性,尤其置入DES后各时期支架血栓的发生情况及其影响因素.方法 连续入选2003年7月至2005年6月期间在北京安贞医院接受冠状动脉介入（PCI）并置入至少1枚DES的所有患者.根据肌酐清除率（Ccr）将患者分为2组：Ccr≥60 ml/min组（肾功能正常或轻度肾功能不全）和Ccr＜60 ml/min组（中重度肾功能不全）.记录所有患者的临床资料,并根据ARC Dublin定义判定支架血栓事件.比较2组患者的主要不良心脑血管事件（MACCE）及各期支架血栓（ST）发生率.结果 共入选2377例患者,Ccr≥60 ml/min组2020例（85.0%）,Ccr＜60 ml/min组357例（15.0%）.Ccr＜60 ml/min组患者的随访期病死率高于Ccr≥60 ml/min组[4.5%（15/334）与1.2%（22/1859）,P＜0.001],但2组患者间急性期、亚急性期、晚期和晚晚期ST的发生率均无差异（P均＞0.05）.Cox多因素回归分析结果提示,肾功能本身并非死亡的危险因素,冠状动脉多支病变（OR=1.929,95%CI=1.178～3.157,P=0.009）、糖尿病（OR=1.914,95%CI=1.055～3.470,P=0.033）和年龄（OR=1.051,95%CI=1.005～1.099,P=0.030）为中重度肾功能不全患者置入DES后死亡的独立危险因素.结论 高危患者使用DES的远期病死率较高,但风险的增加并不归咎于支架血栓的增加.Objective To understand the application of drug eluting stent （DES） in renal functional insufficient patients, and to assess its safety and effectiveness, especially the occurrence of stent thrombosis（ST） after DES implantation and its related factors. Methods The subjects were all the patients underwent percutaneous coronary intervention （PCI） as well as at least one DES admitted to Beijing Anzhen Hospital consecutively from July 2003 to June 2005. All patients were divided into 2 groups： Group Ⅰ with normal or mild renal insufficiency （Ccr≥60 ml/min）,and Group Ⅱ with moderate to severe renal functional insufficiency （Ccr 〈 60 ml/min）. All of the clinical, angiography and intervention data were recorded. ST was adjudicated by the definition of ARC Dublin. The rates of MACCE in hospital and during the follow-up between the 2 groups were compared. Results There were 2377 patients enrolled in the study, of which 2020 （ 85.0% ） patients presented Ccr ≥ 60 ml/min, and 357（ 15.0% ） presented Ccr 〈 60ml/min. The case fatality during follow-up in group Ⅰ was significantly higher than that in group Ⅱ （ 4. 5% vs. 1.2% , P 〈 0. 001 ） . However, the incidences of ST were not significantly different between each stage of disease（ P 〉 0. 05 ）. The results from Cox regression showed that renal functional insufficiency was not a risk factor of death,whereas multivessel coronary artery disease [ OR = 1. 929 （95% CI： 1. 178 -3. 157） , P = 0. 009 ], diabetes [ OR = 1.914 （ 95 % CI： 1. 055 - 3. 470）, P = 0. 033 ] and age [ OR = 1.051 （ 95 % CI： 1. 005 - 1. 099 ） , P = 0. 030 ] were independent risk factor of death after DES implantation in patients with moderate to severe renal functional insufficiency. Conclusions Compared with normal renal function or mild renal patients, the longterm case fatality is higher in moderate and severe renal functional insufficiency patients. However, the higher case fatality does not due to the increase of ST.

关 键 词：药物洗脱支架 肾功能不全 支架血栓 

分 类 号：R541.4[医药卫生—心血管疾病]