冠心病患者血清阴离子间隙与左心室收缩功能的相关性研究

The Serum Anion Gap Is Associated with Left Ventricular Systolic Function in Coronary Artery Disease

目的评价冠状动脉粥样硬化性心脏病(冠心病,CAD)患者血清阴离子间隙(AG)水平与CAD患者左心室收缩功能的关系。方法连续入选2004年4月1日~2010年10月31日在5家临床中心就诊的18 115例冠心病患者,均接受了冠状动脉造影检查及经皮冠状动脉介入治疗。血清AG根据以下公式计算:AG=[Na+(mmol/L)+K+(mmol/L)]-[Cl-(mmol/L)+HCO3-(mmol/L)]。根据左室射血分数(LVEF)评估患者的左心室收缩功能。结果共有4510例(24.9%)患者血清AG水平超过16 mmol/L,左室收缩功能不全患者血清AG水平显著升高。血清AG水平最高四分位数组左室收缩功能下降的相对风险(OR)是AG水平最低四分位数组的1.355(未校正,P<0.001)和1.158倍(校正后,P=0.049)。在剔除e GFR<60 ml/(min·1.73 m2)的AKD患者后,血清AG水平仍然是左室收缩功能下降的显著独立相关因素。结论 CAD患者中血清AG升高占有较高的比例,合并心功能不全的患者中比例更高,血清AG水平是左室收缩功能的显著独立相关因素。

Objective Aims To evaluate the associations between the serum anion gap （AG） with left ventricular systolic function in coronary artery disease （CAD）. Methods From April 2004 to October 2010, a total of 18 115 CAD patients were enrolled. All participants underwent clinically indicated coronary angiography and percutaneous coronary intervention. The serum AG was calculated according to the following equation： AG = [Na＋ （mmol/L） ＋ K＋ （mmol/L）] - [Cl- （mmol/L） ＋ HCO3- （mmol/L）]. Grades of left ventricular systolic function comprised normal （defined as ≥ 50%）, preserved （40%-49%）, and reduced （〈 40%） LVEF. Results A total of 4510 （24.9%） participants had their AG levels greater than 16 mmol/L. And the serum AG was significantly higher in patients with reduced LVEF. The serum AG was independently associated with the grades of left ventricular systolic function. Patients in the 4th quartile of serum AG had a 1.355-fold increased risk of worse left ventricular systolic function （P〈0.001）. This association was robust, even after adjustment for all confounders （OR： 1.158, P=0.049）. After excluding participants with eGFR 〈60 ml/min/1.73 m2, increased AG was still associated with worse left ventricular systolic function. Conclusion In this large population-based study, our findings reveal a high percentage of increased serum AG in CAD and higher AG values in CAD comorbidited with worse left ventricular systolic function.