肾功能不全老年急性冠状动脉综合征患者远期预后评估

Long-Term Prognosis Assessment of Renal Dysfunction in Elder Patients With Acute Coronary Syndrome

目的:评价肾功能不全老年急性冠状动脉综合征(ACS)患者的临床特点与远期预后。方法:对184例ACS合并肾功能不全的老年患者,根据患者肾小球滤过率(glomerular filtration rate,GFR)值分为:轻度肾功能不全组[GFR>60 ml/(min.1.73 m2)]28例;中度肾功能不全组[GFR>30～60 ml/(min.1.73 m2)]81例;重度肾功能不全组[GFR>15～30 ml/(min.1.73 m2)]45例;肾功能衰竭组[GFR<15 ml/(min.1.73 m2)]或透析30例。记录临床资料并进行随访,记录主要心血管不良事件,包括住院期间死亡、并发症以及随访中死亡、心源性休克、心肌梗死。结果:184例患者平均年龄(73.7±9.4)岁,其中男性59.2%(109/184)。轻度肾功能不全组、中度肾功能不全组、重度肾功能不全组、肾功能衰竭组(肾功能逐渐降低)的血清肌酐、高敏C反应蛋白、血清胱抑素C、N端B型利钠肽前体值逐渐升高,而GFR、血红蛋白、左心室射血分数则逐渐降低,4组间比较差异有统计学意义(P均<0.05)。平均随访(502.2±203.6)天。按照美国心脏病学会/美国心脏病协会对病变进行分级,轻度肾功能不全组以A型病变为主,而肾功能衰竭组以C型病变为主。出院预后:主要心血管不良事件(包括心肌梗死)的发生率4组间比较差异均有统计学意义(P<0.01)。结论:肾功能不全严重程度是老年ACS主要心血管不良事件、远期预后不良的独立预测因素,重度肾功能不全以及肾功能衰竭预示患者预后不良。

Objective ：To assess the clinical characteristics and long term prognosis of renal dysfunction （RD） in elder patients with acute coronary syndrome （ACS）. Methods ：A total of 184 ACS patients with renal dysfunction were studied. The patients were divided into 4 groups according to estimated glomerular filtration rate （GFR）. Mild RD group, n = 28, GFR〉60 ml/（ min/l. 73 m2 ）, Moderate RD group, n = 81, GFR〉30 - 60 ml/（ rain/1.73 m2）, Severe RD group, n = 45, GFR〉 15 - 30 ml/（ min/1.73 m2）, and Renal failure group, n = 30, GFR〈15 ml/（ min/1.73 m2 ）. The clinical information and major adverse cardiac vents （MACE） were recorded and followed-up for the median of （502. 2 ± 203.6） days. Results：The patients mean age was （73.7±9. 4） years,and 59.2% （109/184） with male gender. The hs-CRP,serum Cys- tatin C and NT-proBNP increased accordingly from Mild RD group to Moderate RD group, Severe RD group and Renal failure group, all P〈0. 05. While GFR,hemoglobin level and LVEF decreased accordingly, all P〈0. 05. Upon ACC/AHA classification, The patients in Mild RD group were mainly with A lesion and in Renal failure group were mainly with C lesion. The out of hospital MACE occurrence including myocardial infarction had statistic differences among 4 groups,all P〈0. 01. Conclusion：RD degree was the independent risk factor for MACE occurrence in elder ACS patients. Severe RD and renalfailure implied poor prognosis in elder ACS patients.