中度肾功能不全是女性冠心病患者不良预后独立预测因素

Mild chronic kidney disease independently predicts adverse outcomes in women with symptoms and signs of ischemia

目的:探讨中度慢性肾病(CKD)作为有心肌缺血症状女性患者不良预后的独立预测因素的可行性。方法:连续选择269例住院接受冠脉造影的女性患者,根据其肾小球滤过率(e GFR)进行分组。采用调整基线变量的多变量回归分析研究入组患者全因病死率、心血管疾病病死率及主要不良事件的发生率。结果:阻塞性冠状动脉疾病(CAD)患者仅占41%。在调整了CAD严重程度评分后,肾功能仍是对全因及心血管病死率的可靠独立预测因素(P<0.001)。评估肾小球滤过率(e GFR),e GFR每降低10 U,全因病死率增加13%,心血管疾病病死率增加17%,不良心血管事件的发生增加8%。结论:仅中等程度的CKD可作为有或无心肌缺血症状的女性患者全因及因心血管疾病死亡的独立预测因素。

Objective： To investigate mild chronic kidney disease（ CKD） independently predicts adverse outcomes in women with symptoms and signs of ischemia. Methods： To categorize 269 women referred for clinically indicated coronary angiography according to estimated glomerular filtration rate（ e GFR）. Time to death from all-cause and cardiovascular causes and major adverse outcomes were assessed by multivariate regression adjusted for baseline covariates. Results： Obstructive coronary artery disease（ CAD） was present only in few patients（ 41%）. Even after adjusting for CAD severity,renal function remained a strong independent predictor of all-cause and cardiac mortality（ P〈0. 001）. Every 10-unit decrease in e GFR was associated with a 13% increased risk of all-cause mortality,17% increased risk of cardiovascular mortality,and 8% increased risk of adverse cardiovascular events. Conclusion： Even mild CKD is a strong independent predictor of all-cause and cardiac mortality in women with symptoms / signs of ischemia.