冠心病合并终末期肾病治疗决策的选择研究

The Choice of Therapeutic Options for Coronary Heart Disease with End-stage Renal Disease

背景冠心病合并终末期肾病(ESRD)患者心血管死亡风险高,由于血管病变重,病情复杂,可研究病例数少,现有的研究大部分将其排除在外,关于冠心病合并ESRD患者的最佳治疗决策目前众说纷纭,尚无定论。目的探讨冠心病合并ESRD患者的最佳治疗策略。方法选取2012-2018年中日友好医院收治的100例冠心病合并ESRD患者为研究对象,根据冠状动脉造影结果结合心内科和心外科医生判断以及患者的意愿,分为冠状动脉旁路移植术(CABG)组20例、经皮冠状动脉介入治疗(PCI)组44例和药物治疗组36例,比较各组住院期间并发症发生率、病死率、随访期间全因死亡率、心源性死亡率、主要不良心血管事件(MACE)发生率。结果CABG组、PCI组、药物治疗组患者住院期间并发症发生率分别为15.0%(3/20)、11.4%(5/44)、11.1%(4/36),病死率分别为15.0%(3/20)、9.1%(4/44)、8.3%(3/36),随访期间全因死亡率分别为40.0%(8/20)、36.4%(16/44)、27.8%(10/36),心源性死亡率分别为15.0%(3/20)、27.3%(12/44)、16.7%(6/36),MACE发生率分别为20.0%(4/20)、36.4%(16/44)、33.3%(12/36),三组间比较差异均无统计学意义(P>0.05)。结论对于冠心病合并ESRD患者,选择血运重建治疗相对于药物保守治疗,并无明显优势。

Background There is a high risk of death in patients with coronary heart disease(CHD)combined with end-stage renal disease(ESRD)because of cardiovascular diseases.Most of the available studies exclude cases of this kind of special situation,because of the severe and complex coronary lesions and the small number of research cases.There are different viewpoints on the therapeutic options for patients with CHD and ESRD at present,while the best treatment decision is still inconclusive.Objective To explore the best treatment strategy for patients with CHD and ESRD.Methods A total of 100 patients with CHD and ESRD who were treated in China-Japan Friendship Hospital from 2012 to 2018 were selected as the research subjects.According to the results of coronary angiography combined with the judgments of cardiologists and cardiac surgeons and wishes of patients,these patients were divided into coronary artery bypass grafting(CABG)group(20 cases),percutaneous coronary intervention(PCI)group(44 cases)and drug treatment group(36 cases).The incidence of complications,mortality rate,all-cause mortality rate,cardiogenic mortality rate,and the incidence of major adverse cardiovascular event(s MACE)were compared among groups.Results The incidence of complications of patients in the CABG group,PCI group and drug treatment group during hospitalization were 15.0%(3/20),11.4%(5/44)and 11.1%(4/36),and the mortality rates were 15.0%(3/20),9.1%(4/44)and 8.3%(3/36).The all-cause mortality rates during follow-up were 40.0%(8/20),36.4%(16/44)and 27.8%(10/36).The cardiogenic mortality rates were 15.0%(3/20),27.3%(12/44)and 16.7%(6/36).The incidence of MACE were 20.0%(4/20),36.4%(16/44)and 33.3%(12/36).There was no significant difference among three groups(P>0.05).Conclusion For patients with CHD and ESRD,revascularization therapy has no obvious advantage over drug treatment.