1031例冠脉造影患者慢性肾脏病流行情况调查

Epidemiology investigation of chronic kidney disease in 1031 consecutive cases undergoing coronary angiography

目的调查疑似冠心病行冠脉造影患者的慢性肾脏病（CKD）流行情况。方法2008年12月至2009年10月，于东南大学附属中大医院心内科住院行选择性冠脉造影的1031例患者为对象，观察其CKD的患病率及其危险因素。CKD的定义为eGFR〈60ml·min^－1·（1．73m^2和（或）蛋白尿，eGFR以简化MDRD公式计算。冠心病定义为至少1支冠脉狭窄≥50％。结果患者平均年龄（64．37±11．02）岁，其中男性543例，女性488例；冠心病551例，CKD134例（13％）。冠心病组CKD的患病率显著高于非冠心病组（18．33％比6．88％，P〈0．01）。随冠脉病变支数增加（0、1、2、3支），eGFR逐渐下降[（84．24±19．00）、（81．61±23．92）、（75．16±20．99）、（73．92±20．66）ml·min^-1·（1．73m^2）^-1，P〈0．011；蛋白尿患者比例逐渐增加（0．42％、0．82％、1．96％、3．25％，P=0．006）；CKD患病率逐渐增高（6．88％、13．11％、21．57％、23．38％，P〈0．01）。Logistic回归提示年龄增长（OR=1．094，95％CI1．068～1．120）、冠脉病变支数增加（OR=1．288，95％CI1．074—1．543）、高血压（OR=1．974，95％CI1．082～3．603）、心脏收缩功能不全（OR=3．183，95％C11．696～5．972）、高尿酸血症（OR=5．366，95％C13．224—8．931）是CKD的重要危险因素。结果冠脉造影证实的冠心病患者中，CKD患病率显著高于非冠心病者，且随冠脉病变支数增加而显著增加。年龄增长、冠脉病变支数增加、高血压、心脏收缩功能不全、高尿酸血症为CKD的危险因素。

Objective To investigate the prevalence of CKD in coronary angiography with suspected coronary heart disease （CHD）. Methods patients underging A total of 1031 patients with suspected CHD undergoing coronary angiography in Zhongda Hospital from December 2008 to October 2009 were enrolled in the study. The prevalence of CKD and associated risk factors were analyzed. GFR was estimated with MDRD equation. CKD was defined as eGFR 〈60 ml·min^-1 ·（1.73 m^2）^-1 or proteinuria. Luminal narrowing at least one lesion ≥50% in the main branches of coronary artery was considered as CHD. Results The mean age of patients were （64.37±11.02） years. There were 543 males and 488 females, including 551 patients with CHD and 134 patients with CKD（13%）. Patients with CHD had a significantly higher prevalence of CKD compared with patients without CHD （18.33% vs 6.88%, P〈0.01）. With the increasing number of stenosis coronary vessels （n=0, 1, 2, 3）, eGFR was declined [（84.25±19.00）, （81.61±23.92）, （75.16±20.99）, （73.92±20.66） ml ·min^-1 ·（1.73 m^2）^-1, P〈0.01], the percentage of proteinuria increased （0.42%, 0.82%, 1.96%, 3.25%, P=0.006）, and the prevalence of CKD increased （6.88%, 13.11%, 21.57%, 23.38%, P〈0.01）. Logistic regression analysis indicated that increasing age （OR 1.094, 95%CI 1.068 to 1.120）, increasing number of stenosis coronary vessels （OR 1.288, 95%CI 1.074 to 1.543）, hypertension （OR 1.974, 95%CI 1.082 to 3.603）, cardiac systolic insufficiency （OR 3.183, 95%CI 1.696 to 5.972）, and hyperuricemia （OR 5.366, 95%CI 3.224 to 8.93l） were risk factors for CKD. Conclusions The prevalence of CKD in patients with CHD diagnosed by coronary angiography is quite high. Aging, elevated number of stenosis coronary vessels, hypertension, cardiac systolic insufficiency and hyperuricemia are important risk factors for angiographic patients with CKD.