慢性肾衰竭合并冠状动脉粥样硬化性心脏病患者的药物应用

Application of Drugs for the Diagnosis and Treatment of Coronary Artery Disease in Patients with Chronic Renal Failure

慢性肾衰竭可以通过多种病理生理途径诱导和促进动脉粥样硬化,患者心血管事件的发生率和病死率也因此增多。冠心病诊治过程中使用的药物可对肾脏产生影响,如造影剂、阿司匹林、他汀类药物、β受体阻滞剂以及血管紧张素转换酶抑制剂等。当前对慢性肾衰竭患者冠心病诊治中临床药物应用的研究主要是基于小规模前瞻性或回顾性的对照试验,并没有较多的指南推荐,因此冠心病二级预防的治疗是否同肾功能正常患者一样获益仍不清楚。

Chronic renal failure induces and promotes cardiovascular atherosclerosis through various pathophysiological pathways.Patients with chronic renal failure are exposed to the increased morbidity and mortality due to cardiovascular events.The diagnosis and treatment of coronary artery disease need multiple medications,such as contrast agents,aspirin,statins,β-receptor blockers,and renin-angiotensin blockers,which may have side effects on kidneys.Current treatment strategies are based upon the small prospective studies or retrospective analyses of controlled trials and registry data,with fewer guideline-recommended modalities.Therefore,it is unclear whether chronic renal failure patients may benefit from the modern secondary preventive treatments in the same manner as patients with normal renal function.