冠心病患者肾功能与冠状动脉病变程度的关系

The study of renal function and lesion degree of coronary artery in patients with coronary artery disease

目的 探讨冠心病患者肾功能与冠状动脉病变程度的关系.方法 根据基础肾小球滤过率（GFR）将连续299例接受冠状动脉造影患者分为3组：肾功能正常组144例,GFR〉90 ml/（min×1.73m2）;肾功能轻度减退组97例,GFR 60～89ml/（min×1.73 m2）;肾功能中度减退组58例,GFR〈60ml/（min×1.73 m2）;再分别根据入院检查的尿常规（0、微量、1＋、2＋、3＋）将患者分为2组：尿蛋白阴性组171例,尿蛋白阳性组128例,比较各组间的临床特点及冠状动脉病变情况.结果 随着肾功能减退及蛋白尿的产生,冠心病发生率（66.7%、70.1%和72.4%,P〈0.05,64.2%和75.0%,P〈0.05）增高,多支血管病变明显增多,冠状动脉病变积分[（15.0＋14.7）、（19.0±20.0）和（22.0±21.2）,（15.2±16.0）和（20.4±20.2）]增高.结论 慢性肾功能减退及蛋白尿是冠状动脉病变的危险因素,尤其在肾脏受损的早期蛋白尿检查更加重要.

Objective To analyze the angiographic morphologic features of the patients with chronic kidney dysfunction and coronary artery disease. Methods According to the glomerular filtration rate （GFR） 299 consecutive patients who had undergone coronary angiography were divided into 3 groups： group Ⅰ consisted of 144 patients with normal renal function GFR〉90 ml/（minxl.73 m^2）,group Ⅱ included 97 patients with mild renal impairment GFR 60-89 ml/（minxl.73 m^2）,and group Ⅲ comprise 58 patients with medium renal impairment GFR〈60 ml/（min×1.73 m^2）. Then according to the albuminuria（0,minim, 1＋,2＋ ,3＋） patients were divided into 2 groups： the albuminuria negative group included 171 patients, albuminuria positive group included 128 patients. Clinical features and coronary lesion characteristics were compared among the groups. Results Patients with more severe renal dysfunction and positive albuminuria higher incidence rate of coronary artery disease （66.7% vs 70.1% vs 72.4% ,P〈0.05 and 64.2% vs 75% ,P〈0.05） and muhivessel disease, and coronary jeopardy score [（15±14.7） vs （19±20.0） vs （22±21.2） and （15.2±16.0） vs （20.4±20.2）] increased too. Conclusion Chronic renal dysfunction and albuminuria may be important factors determining the occurrence and the severity of coronary artery disease. Especially it is more significant to inspect albuminuria at the early stage of renal dysfunction.