慢性肾脏病和冠状动脉病变危险分层的关系

Relationship between chronic kidney disease and risk stratification of coronary artery lesions

目的研究估算肾小球滤过率（estimated glomerular filtration rate,e GFR）及蛋白尿与冠状动脉病变之间的关系。方法回顾性分析251例接受冠状动脉造影患者的病历资料。根据e GFR将慢性肾脏病（chronic kidney disease,CKD）分为1~5期;按照美国心脏病学院临床数据标准,根据冠状动脉造影的结果将冠状动脉病变分为低、中和高危。结果 224例患者存在冠状动脉病变,其中41.5%具有中-重危风险。经不同模型的多变量Logistic回归分析,蛋白尿不是中-重危冠状动脉病变的危险因素,而CKD每进展1期,发生中-重危冠状动脉病变危险增加55.4%（95%可信区间1.108~2.013）。CKD 1期、2期和3~4期,发生中-重危冠状动脉病变的比例分别为24.1%、29.1%和52.9%。无病变组、低危组、中危组和高危组e GFR分别为（75±19）、（68±20）、（49±17）和（42±15）m L/（min·1.73 m2）,中危组和高危组e GFR显著低于无病变组和低危组,高危组e GFR低于中危组,差异有统计学意义（P〈0.05）。结论蛋白尿可能不是冠状动脉病变的危险因素,而e GFR是冠状动脉病变的重要危险因素,e GFR下降可能反映了更严重的冠状动脉病变。

Objectives To investigate the relationship between the risk stratification of coronary artery lesions and chronic kidney disease（CKD） using the markers of estimated glomerular filtration rate（e GFR） and proteinuria.Methods Clinical data of 251 patients undergoing coronary arteriography were reviewed retrospectively. The severity of CKD was classified into 5 stages according to e GFR level. Based on the American College of Cardiology Task Force on Clinical Data Standards,the arteriographic results,which indicated the severity of coronary artery lesions, were classified into low risk,moderate risk and high risk. Results Of the 251 patients undergoing coronary arteriography, 224 patients had coronary artery lesions, including 93（41.5%） patients with lesions at moderate to high risk. In multiple Logistic regression models, proteinuria was not associated with coronary artery lesions at moderate to high risk, however, the risk of coronary artery lesions at moderate to high risk increased 55.4%（95% confidence interval ： 1.108-2.013） by each increase of CKD stage. The percentages of patients with moderate to high risk of coronary artery lesions in CKD stage 1, stage 2 and stage 3 to 4 groups were 24.1%, 29.1% and 52.9%, respectively. The e GFR levels of patients with different severity of coronary artery lesions in non-lesion, mild risk, moderate risk and high risk groups were（75±19）,（68 ±20）,（49 ±17） and（42 ±15） m L /（min·1.73 m2）, respectively. Compared with patients with different severity of coronary artery lesions in non-lesion and mild risk groups, patients with coronary artery lesions in moderate risk and high risk groups had lower e GFR levels（P〈0.05）. Conclusions Proteinuria might not be a risk factor of coronary artery lesions, however, e GFR may be a risk factor of coronary artery lesions. Decreasing in e GFR may indicate the risk of coronary artery lesions.