肾移植患者冠状动脉造影及介入治疗的临床应用(附6例报告)

Coronary angiography and percutaneous coronary intervention in kidney transplant patients:a report of 6 cases

目的了解肾移植患者合并冠心病的临床特征,分析对此类患者行冠状动脉造影及介入治疗的安全性和有效性。方法入选2005年至2011年在我院心内科接受冠脉造影的6例肾移植患者,对一般资料、冠脉造影及预后情况进行回顾性分析。结果 6例肾移植患者中,3例冠脉造影阴性,另3例合并糖尿病的患者经冠脉造影确诊为冠心病。确诊为冠心病的3例患者中,1例为不稳定性心绞痛,分2次行支架植入,共植入5根支架;1例诊断为急性下壁心肌梗死,冠脉造影提示右冠脉完全闭塞,植入2根支架;1例诊断为急性非ST段抬高心肌梗死,冠脉造影提示3支血管多节段弥漫病变,未能植入支架。6例患者造影前和造影后肾功能指标相比差异无统计学意义,随访期间所有患者未出现肾功能恶化。结论对肾移植患者进行冠脉造影及介入治疗是安全、可行的,可显著提高肾移植患者的生存质量。

Objective To observe the clinical characteristics of kidney transplant patients combined with coronary heart disease, and to analyze the safety and efficacy of coronary angiography and percutaneous coronary intervention for them. Methods Six kidney transplant patients underwent coronary angiography in our department between 2005 and 2011. The clinical characteristics, coronary angiography data and prognoses of the patients were retrospectively analyzed. Results Three patients had normal coronary angiograms and the other 3 combined with diabetes mellitus also had coronary heart diseases as found by coronary angiography. One case had unstable angina and was implanted with a total of 5 stents during 2 sessions. Another case had acute inferior wall myocardial infarction （caused by complete occlusion of the right coronary artery） was implanted with 2 stents. The other case had acute non-ST-segment elevation myocardial infarction and coronary angiography revealed multi-segment diffuse lesions in 3 arteries; stent implantation failed in this patient. There was no significant difference in renal functions before and after coronary angiography in the 6 patients, and there was no deterioration of renal function during the follow-up. Conclusion Coronary angiography and percutaneous coronary intervention are safe and feasible for kidney transplant patients, and they can greatly improve the quality of life of the patients.