轻度肾功能不全与急性冠状动脉综合征预后的相关性  

The predictive value of mild renal insufficiency on the prognosis of patients with acute coronary syndrome

作　　者：张建华[1] 徐岩[1] 陈旭华[1] 伍梦佐[1] 程自平[1] 陈斌[1] 

机构地区：[1]安徽医科大学第一附属医院心内科,合肥230022

出　　处：《中华内科杂志》2013年第12期1033-1036,共4页Chinese Journal of Internal Medicine

基　　金：安徽省科技攻关项目（09010302083）;安徽省卫生厅医学科研重点项目（20108005）

摘　　要：目的分析轻度。肾功能不全对急性冠状动脉综合征患者（ACS）终点事件的预测价值。方法按估算的肾小球滤过率（eGFR）水平不同，将552例ACS患者分为肾功能正常组（eGFR≥90ml·min～·1．73m。）与轻度肾功能不全组（eGFR60-〈90ml·min-1·1．73M-1），前瞻性随访并分析轻度肾功能不全与ACS患者终点事件的相关性。结果轻度肾功能不全组患者初级终点事件的发生率高于肾功能正常组[31例（12．6％）比15例（4．9％），P=0．001]，次级终点事件的发生在两组问差异无统计学意义。初级终点事件中全因死亡[22例（8．9％）比7例（2．2％），P〈0．001]及心源性死亡[16例（6．5％）比4例（1．3％），P=0．001]的发生率在轻度肾功能不全组较高，而非致死性卒中及心肌梗死的发生两组问差异无统计学意义。COX回归模型分析结果发现，轻度肾功能不全患者发生初级终点事件的相对危险度是肾功能正常患者的2．265倍（95％CI1．076—4．771，P=0．031），对各单独事件进一步分析表明轻度肾功能不全对全因死亡有预测价值（HR3．118，95％CI1．197～8．125，P=0．020）。初级终点事件及全因死亡的Kaplan—Meier曲线显示，轻度。肾功能不全组患者的初级终点事件（P=0．004）及全因死亡（P=0．001）的发生率高于肾功能正常组。结论轻度‘肾功能不全对ACS患者的初级终点事件具有重要预测价值。Objective To investigate the predictive value of mild renal insufficiency on the endpoint events in patients with acute coronary syndrome （ACS）. Methods A total of 552 patients with ACS were enrolled in the present study. According to the levels of estimated glomerular filtration rate （eGFR）, patients were divided into two groups, normal renal function （eGFR〉~90 ml ~ min-l ~ 1.73 m-2） and mild renal insufficiency （60~〈eGFR 〈90 ml ~ min-1 ~ 1.73 m-2 ）. The primary and secondary events were collected and analyzed through the present prospective follow-up study. Results The patients in mild renal insufficiency group had a higher incidence of the primary endpoint events than normal renal function group [31 cases （ 12. 6% ） vs 15 cases （4. 9% ）, P =0. 001 ]. There was no difference of the secondary endpoint events incidence in the two groups. The incidence rate of all-cause mortality [8.9% （22 cases） vs 2. 2% （7 cases）, P 〈0. 001 ] and cardiac death [6. 5% （ 16 cases） vs 1.3% （4 cases）, P =0. 001 ] was higher in mild renal insufficiency group, but there was no statistical difference of incidence rate of no fatal stroke and myocardial infarction in the two groups. The results of COX regression analysis showed that the incidence of primary endpoint events in patients with mild renal dysfunction was 2. 265 folds （95% CI 1. 076-4. 771, P =0. 031 ） of patients with normal renal function. Further analysis indicated that the predictive value of mild renal insufficiency was only for all-cause mortality （HR 3. 118, 95% CI 1. 197-8. 125, P =0. 020） , not for heart failure and revascularization. According to the Kaplan-Meier curves results, the incidences of the primary endpoint events （ P = 0. 004 ） and all-cause mortality （ P = 0. 001 ） were higher in mild renal insufficiency group than in normal renal function group. Conclusion Mild renal insufficiency has important predictive value for primary endpoint events in patients with ACS.

关 键 词：肾功能不全 冠状动脉疾病 

分 类 号：R541.4[医药卫生—心血管疾病]