肾小球滤过率与冠状动脉支架内再狭窄的相关性分析

Correlation of estimated glomerular filtration rate with incidence of in-stent restenosis in patients with drug-eluting stent

目的:探索冠状动脉(冠脉)药物洗脱支架植入(以下简称支架植入)术后随访期估算肾小球滤过率(estimated glomerular filtration rate,e GFR)与支架植入术后再狭窄(in-stent restenosis,ISR)间的关系。方法:以中国冠状动脉斑块进展多因素回顾分析研究中的患者为对象,病例均于2010年1月至2016年7月间在各中心进行冠脉造影检查,并在之后12~24个月(平均为13个月)内进行冠脉造影复查,采用二元Logistics回归分析评估随访期eGFR与ISR间的关系,初步探索导致ISR发生的危险因素。结果:本研究共纳入符合标准的冠心病患者1790例,随访期全体患者eGFR平均值为89.97 mL/(min·1.73m^2),按照随访期复查冠脉造影有无ISR,分为ISR组(n=200)和无ISR组(n=1590)。其中,ISR组患者在随访期间的eGFR低于无ISR组[(86.50±25.69)m L/(min·1.73 m^2)比(90.64±26.59)mL/(min·1.73 m^2),P=0.038]。二元Logistics回归分析提示,导致ISR的危险因素包括植入支架的个数(OR=1.478,95%CI 1.177~1.855,P=0.001)、基线期C反应蛋白升高(OR=1.006,95%CI 1.002~1.011,P=0.007),而随访期间相对较高的eGFR是ISR的保护性因素(OR=0.990,95%CI 0.982~0.999,P=0.022)。结论:在eGFR基本正常的冠心病患者中,较低的随访期e GFR水平与其接受冠脉药物洗脱支架植入术后的ISR发生率密切相关。

Objective:To evaluate correlation of estimated glomerular filtration rate with occurrence of in-stent restenosis(ISR)in patients treated with drug-eluting stent(DES)implantation during follow-up period.Methods:Patients undergone DES implantation in the RIPPER study between January 2010 and July 2016 were enrolled,and coronary angiography was performed again to detect ISR after 12-24 months(with the average time of 13 months).Binary Logistics regression were used to assess the risk factors for in-stent restenosis(ISR),and evaluate the correlation of eGFR with ISR in patients.Results:A total of 1790 patients meeting the inclusion criteria,with the average eGFR of 89.97 m L/(min·1.73 m^2)during follow-up,were divided into ISR group(n=200)and No-ISR group(n=1590).The eGFR in ISR group was significantly lower than No-ISR group[(86.50±25.69)mL/(min·1.73 m^2)vs.(90.64±26.59)mL/(min·1.73 m^2),P=0.038].Binary Logistics regression showed that the risk factors for ISR were number of implanted stent[OR=1.478,95%CI 1.177-1.855,P=0.001]and increased baseline C-reactive protein level[OR=1.006,95%CI 1.002-1.011,P=0.007],while relatively elevated e GFR during follow-up was protective factor(OR=0.990,95%CI 0.982-0.999,P=0.022).Conclusions:In patients with nearly normal eGFR after DES implantation,relatively lower eGFR is correlated with the incidence of ISR.