估计的肾小球滤过率与传统冠心病危险因素相关性的比较研究

Correlation analysis on estimated glomerular filtration rate and traditional coronary risk factors

目的研究分析行冠脉造影检查患者中估计的肾小球滤过率(esti mated glomerular filtration rate,eGFR)与冠心病传统危险因素的相关性。方法根据简化MDRD公式计算eGFR,将初次行选择性冠脉造影的657例患者分成3组,肾功能正常组:eGFR≥90 mL·min-1.1.73 m-2301例;肾功能轻度减退组:eGFR60～89 mL·min-1.1.73 m-2303例;肾功能中重度减退组:eGFR15～59 mL·min-1.1.73 m-253例。比较各组中eGFR与冠心病各传统危险因素的相关程度。结果肾功能中、重度减退组年龄显著高于肾功能轻度减退组(75岁vs69岁,P<0.001),肾功能轻度减退组年龄显著高于肾功能正常组(69岁vs61岁,P<0.001)。肾功能中、重度减退组,冠心病的患病率显著高于肾功能正常组(77.4%vs56.8%,P=0.004)。收缩压与eGFR直线负相关,相关系数r=-0.082,P=0.036,在收缩压≥125 mmHg时,eGFR<88 mL·min-1.1.73 m-2组冠心病患者百分比高于eGFR≥88 mL·min-1.1.73 m-2组(70.2%vs57.2%,P=0.011)。HDL-C与eGFR呈直线相关,相关系数r=0.095,P=0.016。HDL-C<1.1 mmol/L时,eGFR<88 mL·min-1.1.73 m-2组冠心病患病率高于eGFR≥88 mL·min-1.1.73 m-2组(74.0%vs62.9%,P=0.037)。在高血压亚组中的Logistic回归分析中,轻度肾功能减退的比值比为1.563(P=0.044),肾功能中重度减退的比值比为2.350(P=0.040)。与eGFR≥60 mL·min-1.1.73 m-2相比,eGFR<60 mL·min-1.1.73 m-2时冠心病的关联强度,肾功能中、重度减退的冠心病危险度是肾功能正常或轻度减退的2.176倍,高血压、吸烟、糖尿病、老年对冠心病的危险度分别为1.515、1.566、2.404、3.420。结论慢性肾功能减退与危险因素老年、高血压、HDL-C显著相关,在高血压亚组中,肾功能减退明显是冠心病的独立危险因素。在进行冠心病的预防时需加强对肾功能减退患者的关注。

Objective To assess the relationship between estimated glomerular filtration rate （eGFR） and traditional coronary risk factors. Methods Six hundreds and fifty-seven consecutive patients who had undergone coronary angiography were divided into 3 groups according to baseline renal functional status eGFR：group Ⅰ consisted of 301 patients with normal renal function eGFR〉90mL·min^-1·1.73m^-2;group Ⅱ included 303 patients with mild renal impairment（eGFR 60- 89）; and group Ⅲ comprised 53 patients with moderate and severe renal dysfunction eGFR〈60mL·min^-1·1.73m^-2. Clinical features and coronary risk factors were compared among the 3 groups. Results Patients with moderate and severe renal dysfunction were older than those with mild renal impairment. （median age 75 yrs old vs median age 69 yrs old,P〈0. 001 ） ,while patients with moderate and severe renal dysfunction were older than those with normal renal function （median age 69 yrs old vs median age 61 yrs old, P〈0. 001 ）. The incidence of coronary artery disease（77.4 % vs 56.8 %, P = 0. 004）were significantly higher in group Ⅲ. The level of systolic blood pressure（SBP） was negatively correlated with the level of eGFR（r= -0. 082,P= 0. 036）. Setting the median value of SBP as well as eGFR as cut points,all patients were divided into SBP〈125mmHg and eGFR≥88 mL·min^-1·1.73m^-2 group. The patients with SBP≥125 mmHg and eGFR〈88 mL·min^-1·1.73m^-2had a significantly increased percentage of coronary artery disease （CAD） compared with those with SBP≥125 mmHg and eGFR≥88 mL·min^-1·1.73m^-2（70. 2% vs 57. 2%,P = 0.011）. the level of HDL-C was positively correlated with the level of eGFR（r= 0. 084,P = 0. 008） as well as after controlling for the effects of smoking, aging, BMI, hypertension, dyslipidemia, systolic blood pressure, diabetes and family history of premature CAD（r = 0. 095 ,P = 0. 016）. Setting the median value of HDL-C as we.ll as eGFR as cut points,all patients were divided into HDL-C≥1. 1 mmol/L and eGFR≥88 mL·min^-1·1.73m^-2 group,when HDL-C〈1.1mmol/L,the incidence of coronary artery disease was also higher in patients with moderate and severe renal dysfunction（74. 0% vs 62. 9%, P = 0. 037）. Logistic regression model was used to assess the association of renal insufficiency with CAD in patients with hypertension,in which aging, diabetes, smoking, dyslipidemia, family history of premature CAD were listed as covariates. Moderate and severe renal insufficiency （OR = 2. 350, P = 0. 040） entered the model. Patients with eGFR less than 60 mL·min^-1·1.73m^-2（OR= 2. 176） had an increased risk of CAD compared with those with eGFR more than 60 mL·min^-1·1.73m^-2. The risk degree of CAD caused by hypertension, smoking, diabetes and aging was 1. 515,1. 566,2. 404 and 3. 420 respectively. Conclusions Renal insufficiency was one of the CVD risk factors as well as aging,smoking, diabetes and hypertension, especially in patients with hypertension. It is suggested that patients with renal insufficiency should pay more attention to CAD prevention.