【摘要】：肌酐正常的冠心病患者腎小球?yàn)V過(guò)率對(duì)冠狀動(dòng)脈側(cè)支及尿酸水平[(350.7±96.5)vs(324.0±90.1),P=0.019]出現(xiàn)升高。且差異均有統(tǒng)計(jì)學(xué)意義。Kaplan-Meier生存曲線分析結(jié)果顯示在肌酐正常的冠心病患者中,隨著eGFR水平的降低,MACE發(fā)生率出現(xiàn)明顯上升趨勢(shì)。結(jié)論:肌酐正常范圍內(nèi)的冠心病患者腎小球?yàn)V過(guò)率是側(cè)支循環(huán)不充分重要預(yù)測(cè)因素。而且可以有效預(yù)測(cè)其未來(lái)的不良預(yù)后。目的:初步探討在肌酐正常范圍內(nèi)的冠心病患者腎小球?yàn)V過(guò)率(e GFR)對(duì)冠狀動(dòng)脈側(cè)支循環(huán)的影響及其預(yù)后。方法:入選我院心內(nèi)科導(dǎo)管室2013-05至2014-04首次行冠脈造影結(jié)果示嚴(yán)重血管狹窄(狹窄程度≥95%)且肌酐正常的患者194例。根據(jù)造影側(cè)支循環(huán)Rentrop分級(jí)將患者分為側(cè)支循環(huán)建立不充分組(Rentrop分級(jí)0~1級(jí),共113例)和側(cè)支循環(huán)建立充分組(Rentrop分級(jí)2~3級(jí),共81例),記錄患者的年齡、性別、既往史、血肌酐值、空腹血糖、血脂水平等,通過(guò)腎臟疾病膳食改良(MDRD)研究公式估測(cè)e GFR,采用多因素Logistic回歸模型分析冠脈側(cè)支循環(huán)不充分與e GFR的相關(guān)性。對(duì)入選的患者進(jìn)隨訪,平均隨訪時(shí)間為(8.31±6.02)個(gè)月,以發(fā)生MACE作為終點(diǎn)事件,并按有無(wú)MACE分為兩組,比較兩組間的基線資料,最后將全體入選患者按e GFR水平分為高中低三組,并用Kaplan-Meier生存曲線進(jìn)行分析。結(jié)果:當(dāng)血清肌酐處于正常范圍時(shí),e GFR水平在側(cè)支循環(huán)不充分組較充分組更低[(78.7±20.5)ml/(min·1.73m-2)vs(89.6±3.2 ml/(min·1.73m-2),P=0.012],側(cè)支循環(huán)不充分組的空腹血糖值[(7.5±3.4)mmol/L vs(6.7±2.8)mmol/L,P=0.003],高敏C反應(yīng)蛋白(hs-CRP)水平[(2.7±0.8)mg/L vs(2.3±0.6)mg/L,P=0.029]較側(cè)支循環(huán)充分組更高,Gensini評(píng)分(7.7±3.9 vs 9.1±5.0,P=0.004)較側(cè)支循環(huán)充分組更低,差異有統(tǒng)計(jì)學(xué)意義。多因素Logistic回歸分析顯示,e GFR(OR=0.19,95%CI=0.14~0.22,P=0.027),hs-CRP(OR=1.58,95%CI=1.24~2.44,P=0.028),Gensini評(píng)分(OR=0.98,95%CI=0.97~0.99,P0.001),空腹血糖(OR=1.21,95%CI=1.06~1.41,P=0.002)是側(cè)支循環(huán)不充分的獨(dú)立危險(xiǎn)因素。MACE組患者與無(wú)MACE組患者相比,e GFR水平出現(xiàn)降低[(73.5±18.6)vs(88.4±22.7),P=0.017],hs-CRP[(3.1±0.9)vs(2.6±0.9),P=0.012]
[Abstract]:The glomerular filtration rate (GFR) in patients with coronary heart disease with normal creatinine increased the level of coronary collateral and uric acid [(350.7 鹵96.5) vs (324.0 鹵90.1), P < 0.019]. The results of Kaplan-Meier survival curve analysis showed that the incidence of MACE increased with the decrease of eGFR level in CHD patients with normal creatinine. Conclusion: glomerular filtration rate is an important predictor of collateral insufficiency in patients with coronary heart disease within the normal range of creatinine. And it can effectively predict the future adverse prognosis. Aim: to investigate the effect of glomerular filtration rate (e GFR) on coronary collateral circulation and prognosis in patients with coronary heart disease (CHD) within the normal range of creatinine. Methods: from May 2013 to April 2014, 194 patients with severe stenosis (鈮，

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