糖代谢异常患者肾功能状态对冠脉病变程度的影响

Renal function plays an important role in the pathological changes of coronary artery in a population with abnor- malglucosemetabolism

目的探讨糖代谢异常人群中估算的肾小球滤过率（eGFR）对冠脉病变范围及严重程度的影响。方法采用简化的肾脏疾病饮食改良公式（MDRD）计算eGFR，比较不同MDRD-eGFR组在临床生化指标、狭窄冠状动脉支数、冠状动脉狭窄严重程度积分等方面的差别。结果糖调节受损组、糖尿病组及总体人群中，狭窄冠脉支数、Gensini积分与MDRD—eGFR均呈负相关性（P〈0．05），与肌酐均呈正相关性（P〈0．05）。MDRD-eGFR〈60mL·mm-1·（1．73m2）-1 组狭窄冠脉支数多于60～89mL·min-1·（1．73m2）-1组及≥90mL·min。-1·（1．73m2）-1组，Gemini积分也高于其余两组（均P〈0．05）。校正年龄、空腹血糖、糖化血红蛋白、尿素氮、肌酐及尿酸因素后，狭窄冠脉支数、Gensini积分与MDRD—eGFR之间均呈负相关性，偏相关系数分别为-0．051和-0．022（P〈0．05）。Logistic逐步回归分析显示MDRD—eGFR为发生3支及以上冠脉病变的独立危险因素。结论糖代谢异常人群具有较高的冠心病患病率，肾小球滤过率的下降与冠脉病变程度具有一定的负相关性，且为发生多支冠脉病变（≥3支）的独立危险因素。

Objective To investigate the effect of estimated glomerular filtration rate （eGFR） on the severity of coronary artery disease in patients with abnormal glucose metabolism. Methods The Abbreviated Modification of Diet in Renal Disease （MDRD） formular was used to estimate GFR. To compare the differences in different groups divided by MDRD-eGFR on biochemical parameters, coronary artery stenosis severity and Gensini scores. Results Coronary artery stenosis severity and Gensini scores were inversely associated with MDRD-eGFR, while were positively associated with serum creatinine in the impaired glucose regulation （IGR） group, the diabetes mellitus （DM） group and the whole population （P〈0.05）. Coronary artery stenosis severity and Gensini scores were higher in the moderate reduced GFR group （MDRD-eGFR 〈 60 ml .min-1 · （1.73 m2） -1 than in the mild reduced GFR （60-89 ml ·min-1· （1.73 m2） -1 and normal GFR [≥90 ml ·min-1· （1.73 m2） -1] group （P〈0.05）. There was still a negative relationship between MDRD- eGFR and coronary artery stenosis severity and Gensini scores after adjusting for age, fasting blood glucose, hemoglobin, blood urea nitrogen, serum creatinine and uric acid （P 〈 0.05）. Stepwise logistic regression analysis showed that MDRD- eGFR was an independent risk factor in the severity of coronary artery stenosis. Conclusions Both IGR and DM group have a high prevalence of coronary heart disease. Coronary artery stenosis severity and Gensini scores are inversely associated with GFR. Renal fuction is an independent risk factor in multi-vessel （i〉3） coronary artery.