基础肾功能水平对慢性冠状动脉完全闭塞患者血运重建后的影响

Influence of basic renal function on the improvement of cardiac function after revascularization in patients with coronary chronic total occlusion

目的观察不同肾小球滤过率(eGFR)的慢性冠状动脉完全闭塞性病变(CTO)患者经皮冠状动脉介入(PCI)治疗后心功能的改善情况。方法2017年9月至2018年9月在温州市人民医院和浙江大学医学院附属邵逸夫医院行PCI治疗的CTO患者44例,根据是否诊断为慢性肾病(CKD),分为CKD组24例(eGFR<90 mL·min^-1·1.73 m^-2),非CKD组20例(eGFR≥90 mL·min^-1·1.73 m^-2)。比较两组患者的基线资料、术后第1次肌酐水平,术后1、3、12个月的心脏超声检查结果、纽约心脏协会(NYHA)分级和加拿大心血管协会(CCS)心绞痛分级。结果CKD组术后肌酐(86.4±14.9)umol/L,低于术前(91.8±15.6)umol/L(P<0.05)。非CKD组术前肌酐为(62.3±9.3)umol/L,术后(69.5±15.2)umol/L,差异无统计学意义(P>0.05)。3例患者发生造影剂肾病。术后12个月,非CKD组左心室射血分数(LVEF)为(70.2±4.5)%,高于术前(66.8±5.5)%(P<0.05),NYHA分级和CCS心绞痛分级均降低(均P<0.05)。结论慢性闭塞血管开通后,非CKD者心功能及心绞痛改善大于CKD者。

Objective To observe the influence of basic estimated glomerular filtration rate(e GFR) on the improvement of cardiac function after revascularization in patients with coronary chronic total occlusion(CTO). Methods44 patients with CTO were enrolled from Wenzhou People’s Hospital and Ranran Shaw Hospital Affiliated to Zhejiang University Medical College during September 2017 to September 2018 and divided into group A(e GFR<90 m L·min-1·1.73 m-2, n=24) and group B(e GFR >90 m L·min-1·1.73 m-2, n=20). Baseline clinical data, serum creatinine after procedure, echocardiographic data, NYHA and CCS classification 1, 3 and 12 months later after the procedure were compared between the two groups. Results Serum creatinine was significantly decreased from 91.8 ±15.6 μmol/L pre-operation to 86.4±14.9 μmol post-operation in group A(P<0.05). Serum creatinine was 62.3±9.3 μmol/L before operation and 69.5±15.2 μmol/L after operation in group B(P >0.05). The LVEF was significantly higher 1 year later after operation than that before operation [(70.2±4.5)% vs.(66.8±5.5)%(P<0.05)] in group B. NYHA and CCS classification were significantly lower one year later than before procedure(all P<0.05). Conclusion The improvement of cardiac function and angina pectoris after revascularization of coronary CTO is moreobvious innon-CKD patients than CKD patients.