维持性血液透析患者合并急性冠状动脉综合征行冠状动脉介入治疗的临床分析

Clinical analysis on percutaneous coronary intervention in maintenance hemodialysis patients with acute coronary syndrome

目的探讨维持性血液透析患者合并急性冠状动脉综合征行冠状动脉介入治疗的临床效果及并发症。方法共入选2014年7月~2019年4月在北京积水潭医院规律血液透析且合并急性冠状动脉综合征(acute coronary syndrome,ACS)的患者101例,所有患者均符合冠状动脉造影适应证,根据患者意愿是否接受经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)将患者分为PCI组(n=32)和对照组(n=69)。比较2组患者的一般临床特点、随访3个月时肾功能、残余尿量及左心室射血分数(left ventricular ejection fraction,LVEF)变化,以及出血及心血管并发症的风险及死亡风险。结果①患者的平均年龄为(67.62±12.39)岁。2组患者性别(χ^2=2.889,P=0.089)、年龄(t=-0.775,P=0.440)、透析龄(t=-0.537,P=0.592)、基础尿量(Z=-0.856,P=0.392)、基础LVEF(t=1.781,P=0.078)、血肌酐(Z=-1.522,P=0.128)差异均无统计学意义;②随访3个月时2组患者血肌酐(Z=-1.306,P=0.191)及残余尿量(Z=-1.226,P=0.220)无明显差异,而PCI组的LVEF高于对照组(Z=-4.229,P<0.001);③观察至2019年7月,2组患者出血风险(χ^2=0.155,P=0.694)及再发心血管事件风险(χ^2=1.672,P=0.196)无差异,生存分析显示PCI组的生存时间明显高于对照组(χ^2=4.657,P=0.031)。结论维持性血液透析患者合并ACS行冠状动脉介入治疗能改善患者的左心室射血分数,提高患者生存率;且不增加出血事件及再发心血管事件,不影响患者的残余肾功能。

Objective To investigate the clinical efficacy and complications of percutaneous coronary intervention(PCI)in maintenance hemodialysis(MHD)patients with acute coronary syndrome(ACS).Methods A total of 101 MHD patients with ACS treated in Beijing Jishuitan Hospital from July 2014 to April 2019 were enrolled in this study.They were divided into the PCI group(n=32)and the control group(n=69)based on the acceptance of PCI by the patients.Clinical characteristics,changes of kidney function,residual urine volume,left ventricular ejection fraction(LVEF),bleeding events,cardiovascular complications and mortality were compared between the two groups after the treatment for 3 months.Results①The mean age of the study population was 67.62±12.39 years.There were no statistical differences between the two groups in gender(χ^2=2.889,P=0.089),age(t=-0.775,P=0.440),dialysis age(t=-0.537,P=0.592),basal residual urine volume(Z=-0.856,P=0.392),basal LVEF value(t=1.781,P=0.078),serum creatinine(Z=-1.522,P=0.128).②After the treatment for 3 months,there were no statistical differences between the two groups in serum creatinine(Z=-1.306,P=0.191)and residual urine volume(Z=-1.226,P=0.220),but LVEF value was higher in the PCI group than in the control group(Z=-4.229,P<0.001).③These patients were followed up to July 2019 and found that there were no statistical differences between the two groups in bleeding events(χ^2=0.155,P=0.694)and recurrence of cardiovascular events(χ^2=1.672,P=0.196),but survival period was significantly longer in the PCI group than in the control group(χ^2=4.657,P=0.031).Conclusion For MHD patients with ACS,PCI treatment can improve LVEF value and the survival period without the increase of bleeding events and recurrence of cardiovascular events and the impact on residual renal function.