冠状动脉SYNTAX积分与内生肌酐清除率及颈动脉内膜中层厚度的相关性

Correlation between coronary artery SYNTAX integra and estimated glomerular filtration rate and carotid intima-media thickness in eldly patients with coronary artery disease

目的：探讨老年冠心病患者冠状动脉（冠脉）SYNTAX积分与肾小球滤过率估算值（estimated glomerular filtration rate，eGFR）及颈动脉内膜中层厚度（carotid intima-media thickness，CIMT）的关系。方法：回顾性分析在我院经造影证实3支病变和（或）左主干病变的老年冠心病患者43例，计算SYNTAX积分并进行危险分层，利用Coekcroft-Gault公式计算eGFR，采用超声测定CIMT，分析患者SYNTAX积分与eGFR及CIMT的关系。多元线性回归分析法分析影响SYNTAX积分的危险因素。结果：老年冠心病患者SYNTAX评分与eGFR呈负相关（r=-0．36，P〈0．05）；SYNTAX评分与CIMT呈正相关（r=0．33，P〈0．05）；CIMT与eGFR负相关（r=-0．47，P〈0．05）。将患者以SYNTAX积分（低危0～22分，中危23～32分，高危≥33分）进行分层分析，低危组与中危组、低危组与高危组CIMT差异有统计学意义（P〈0．05），低危组与中危组及高危组eGFR差异有统计学意义（P〈0．05）。eGFR（β=-0．1834，P=0．0024）是SYNTAX积分的独立危险因素。结论：颈动脉内膜的变化与冠脉病变相关；随着老年冠心病患者肾脏功能的减退，动脉粥样硬化有逐渐加重的趋势。

Objective..To study the relationship between coronary artery SYNTAX integra and estimated glomerular filtration rate （eGFR） and carotid intima-media thickness （CIMT） in eldly patients with coronary artery disease. Method： Data of 43 eld patients with left main/three vessel lesion diagnosed by coronary angiogram in our hospital were retrospectively analyzed. SYNTAX score for each patient was calculated according to coronary angiogram. The patients were stratified according to SYNTAX score stratification. Cockcroft-Gault formula was employed to calculate the eGFR. CIMT was determined with B-mode ultrasound. The relationship between SYN- TAX score, eGFR and CIMT was analyzed. Multivariate linear regression analysis was performed to analyze the risk factor of SYNTAX. Result：SYNTAX score of eld patients with coronary artery disease was inversely correlated to the eGFR （r=-0.36, P〈0.05） and the CIMT （r=0.33, P〈0.05）. CIMT were inversely correlated to the eGFR （r=-0.47, P〈0.05）. The patients were divided into three groups： low-risk group （0-22 scores）, mid-risk group （23-32 scores） and high-risk group （≥33 scores） according to the SYNTAX score stratification. Between the low-risk group and mid-risk group or high-risk group, the differences in CIMT were significant （P〈 0.05）. Between the mid-risk group and low-risk group or high-risk group, the difference in eGFR were significant （P〈0.05）. Multivariate linear regression analysis showed that eGFR was the independent risk factor of SYNTAX. Conclusion. The changes of CIMT are associated with the coronary artery lesion. Artery atheroselerosis prone to be aggravation with the kidney function impairment in eld patients with eoranary heart disease.