糖尿病合并冠心病患者冠脉病变严重程度与肾功能的相关性研究

Correlation between severity of coronary lesions and renal function in patients with diabetes mellitus complicated with coronary artery disease

目的探讨糖尿病合并冠心病患者冠脉病变严重程度与肾功能之间的关系。方法回顾性连续收集2015年9月至2017年3月在滁州市第一人民医院心血管内科住院的394例糖尿病合并心绞痛并经冠脉造影证实为冠心病患者临床资料,分别计算以肌酐评价的肾小球滤过率(e GFRScr)及以胱抑素C评价的肾小球滤过率(eGFR_(CysC))。按eGFR_(CysC)大小分为A组(eGFR_(CysC)<30 m L/min,n=23)、B组(30 m L/min≤eGFR_(CysC)<60 m L/min,n=125)、C组(60 m L/min≤eGFR_(CysC)<90 m L/min,n=199)及D组(eGFR_(CysC)≥90 m L/min,n=47)四组。每例患者使用Gensini评分(GS)评价冠脉病变程度。使用Pearson相关方法分析GS和肾功能指标间的相关性。以GS为因变量,利用多元线性回归分析评估自变量之间的独立相关性,并探索影响GS的独立危险因素。结果各组患者间的年龄、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血清肌酐(Scr)、高血压患病率比较差异均有统计学意义(P<0.01),eGFR_(CysC)越低组年龄、LDL-C、TG、高血压患病率越高,HDL-C越低;GS与胱抑素C和肌酐均呈正相关(r=0.702、0.205,P<0.01),GS评分与eGFR_(CysC)和e GFRscr均呈负相关(-0.685、-0.202,P<0.01);高龄(β=0.156,P<0.01)、低HDL-C(β=-0.105,P<0.05)、低eGFR_(CysC)(β=-0.707,P<0.01)是GS较强的危险预测因子。结论 eGFR_(CysC)对预测糖尿病并发冠心病患者冠脉病变严重程度可能有益。

Objective To explore the correlation between severity of coronary lesions and renal function in patients with diabetes mellitus（DM） complicated with coronary artery disease（CAD）.Methods The clinical data of 394 patients with diabetes mellitus complicated with CAD confirmed by coronary angiography in Department of Cardiology,the First People＇s Hospital of Chuzhou from September 2015 to March 2017 were included in this study.Estimated glomerular filtration rate based on both creatinine（e GFRScr） and cystatin-C（eGFR_（CysC）） was computed.According to eGFR_（CysC） level,all the cases were divided into four groups：group A（eGFR_（CysC）30 m L/min,n=23）,group B（30 m L/min≤eGFR_（CysC）60 m L/min,n=125）,group C（60 m L/min≤eGFR_（CysC）90 m L/min,n=199） and group D（eGFR_（CysC）≥90 m L/min,n=47）.The Gensini score（GS） was used to evaluate severity of coronary lesions.Pearson correlations were used to analyze the correlation between GS and renal function indexes.The independent correlation between independent variables was evaluated by multiple linear regression analysis,and the independent risk factors affecting GS were explored.Results The age,total cholesterol（TC）,triglyceride（TG）,high density lipoprotein cholesterol（HDL-C）,low density lipoprotein cholesterol（LDL-C）,serum creatinine（Scr）,and the prevalence of hypertension were significantly different among the four groups（P〈0.01）.In the group with lower eGFR_（CysC）level,the patients has higher age,LDL-C,TG,higher incidence of hypertension,and lower HDL-C.GS were positively correlated with cystatin C and creatinine（r=0.702 and r=0.205,P〈0.001）.GS score was negatively correlated with eGFR_（CysC）and eGFR_（CysC）（r=-0.685 and r=-0.202,P〈0.001）.Low level of eGFR_（CysC）（β=-0.707,P〈0.01）,HDL-C（β=-0.105,P〈0.05） and advanced age（β=0.156,P〈0.01） were strong independent risk factors of GS.Conclusion EGFRCys Chas certain clinical guiding significance for early diagnosis and prediction of severity of coronary artery disease in DM patients with CAD.