估测肾小球滤过率对老年冠心病患者预后影响的研究

The effect of the estimated glomerular filtration rate on prognosis of elderly patients with coronary artery disease

目的研究不同肾功能状态老年冠心病患者的预后。方法将383例确诊为冠心病患者分为老年组和非老年组，老年组根据估测肾小球滤过率（eGFR）四分位法分为GFR1组（eGFR：≥89．55ml·min^-1·1．73m^-2），GFR2组（eGFR：75．54～89．54ml·min^-1·1．73m^-2），GFR3组（eGFR：62．69～75．53ml·min^-1·1．73m^-2）和GFR4组（eGFR：〈62．69ml·min^-1·1．73m^-2），随访约2年，分析各组的累积心血管死亡及发生心血管死亡的相对风险。结果（1）老年组、非老年组累积心血管病死率分别为9．4％（24／255）、1．3％（1／76），两组间差异有统计学意义（P=0．019）；（2）GFR1组、2组、3组的累积心血管病死率分别为6．8％（4／59）、6．3％（4／64）、4．6％（3／65），3组间差异无统计学意义（均P〉0．05）；GFR4组累积心血管病死率为19．4％（13／67），与GFR1组、2组、3组间的差异均有统计学意义（P值分别为0．038、0．025、0．009）；（3）多因素回归分析结果显示，eGFR为影响老年冠心病患者预后的独立危险因素，发生心血管死亡的相对风险为0．965（95％CI为0．946～O．985，p=0．001）。结论eGFR是老年冠心病患者发生心血管死亡的重要预测因素。

Objective To study the effect of different renal functions on the prognosis of elderly patients with coronary neart disease （CHD）. Methods All 383 patients with CHD were divided into elderly group and non elderly group. Then patients in the elderly group were assigned to 4 groups according to the quartile of the estimated glomerular filtration rate （eGFR） ： GFR1 group （eGFR： ≥89.55 ml· min ^-1· 1.73 m^-2）, GFR2 group （eGFR：75.54-89.54 ml· min ^-1 · 1.73 m^-2）, GFR3 group （eGFR：62.69-75.53 ml· min ^-1 · 1.73 m^- 2）, GFR4 group （eGFR： 〈62.69 ml · min ^-1· 1.73 m^-2 ）. All patients were followed up for 2 years, and the cumulative death rate of cardiovascular diseases and the relative risk for cardiovascular death were analyzed. Results （1）The cumulative death rate of cardiovascular diseases in elderly group was higher than that in non-elderly group （9.4% vs. 1.30%, P= 0. 019）. （2）The cumulative death rate of cardiovascular diseases in GFR1,GFR2, GFR3 group were 6.8% ,6.3% ,4.6%, respectively, and there were no statistical differences among the three groups （P〉0. 05）. The cumulative death rate of cardiovascular diseases was 19.4% in GFR4 group, which was higher than that in other three groups （19.4% vs. 6.8%, P=0.038; 19.4% vs. 6.3%, P=0.025 ; 19.4% vs. 4.6%, P=0.009） . （3）Multivariate regression analysis revealed that eGFR was an independent prognosis factor for elderly patients with CHD, and the hazard ratio for cardiovascular death was 0. 965（95% CI：0. 946-0. 985, P=0. 001）. Conclusions eGFR is an imoortant predictor for cardiovascular death in elderly patients with CHD.