血浆大内皮素1可预测慢性肾病患者冠状动脉旁路移植术后远期预后  

Plasma big endothelin-1 predicts long-term outcomes after coronary artery bypass grafting in patients with chronic kidney disease: An observational study

作　　者：喻鹏凌 宋昌鹏 李宝童 武恒朝[1] 向俾桃 孙寒松[1] YU Peng-ling;SONG Chang-peng;LI Bao-tong;WU Heng-chao;XIANG Bi-tao;SUN Han-song(Department of Adult Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, Beijing 100037, China)

机构地区：[1]北京协和医学院中国医学科学院阜外医院成人外科中心,北京市100037

出　　处：《中国心血管病研究》2019年第3期251-255,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的 探讨血浆大内皮素1对慢性肾病患者冠状动脉旁路移植术后远期预后的预测价值.方法 入选2010年1~12月于中国医学科学院阜外医院行冠状动脉旁路移植术的冠心病合并慢性肾功能不全患者.收集并记录患者的临床基线资料,测量血浆大内皮素1水平,对所有入组患者进行随访,记录随访期间死亡和主要不良心脑血管事件.结果 共入组144例患者,平均年龄(63.2±9.9)岁.随访(4.3±0.9)年,随访率92.4%.死亡总人数14例(9.7%),其中8例(5.5%)为心血管疾病相关死亡.相关分析显示,大内皮素1水平与体重指数、肌酐、脑钠肽正相关,与左心室射血分数、估测肾小球滤过率、高密度脂蛋白负相关.多因素Cox比例风险模型分析显示血浆大内皮素1是术后远期死亡的独立危险因素(HR=6.221,95%CI1.455~22.595,P=0.014).应用Kaplan-Meier法分析血浆大内皮素低水平(大内皮素1<0.68 pmol/L)与高水平(大内皮素1≥0.68 pmol/L)患者术后的生存曲线,可见两组统计学差异具有显著性(P<0.05).结论 血浆大内皮素1是慢性肾脏病患者冠状动脉旁路移植术后远期预后的独立预测指标.Objective To assess the prognostic value of big endothelin-1 on the long-term survival in patients with concomitant coronary artery disease and chronic kidney disease (CKD). Methods A total of 144 consecutive CKD patients who underwent coronary artery bypass grafting were enrolled at our center between January 2010 and December 2010. The clinical baseline data were collected and recorded. All patients were followed up. The mortality and major adverse cardiovascular and cerebrovascular events were recorded during the follow-up period. Results The mean age of patients was(63.2 ±9.9)years. During (4.3±0.9)years of follow-up, 14(9.7%) patients died, of whom 8(5.5%) died of cardiovascular causes. The correlation analysis showed that endothelin-1 level was positively correlated with body mass index, creatinine and brain natriuretic peptide and negatively correlated with left ventricular ejection fraction, estimated glomerular filtration rate and high density lipoprotein. Multivariate Cox proportional hazard regression analysis also indicated that big endothelin-1 was independently associated with all-cause mortality [hazard ratio (HR)=6.221, 95% confidence interval (Cl) 1.455- 22.595,P<0.014]. In addition, the Kaplan-Meier curves of the cumulative survival rate stratified by big endothelin-1 level revealed that higher levels (big endothelin-1≥0.68 pmol/L) were associated with shorter event-free survival (P<0.05). Conclusion Plasma big endothelin-1 is an independent prognostic marker of cardiovascular outcomes after coronary artery bypass grafting in patients with CKD.

关 键 词：大内皮素1 冠状动脉旁路移植术 慢性肾病 

分 类 号：R654.2[医药卫生—外科学]