肌酐正常的冠心病患者肾小球滤过率对冠状动脉侧支循环的影响及危险因素

摘要

目的：探讨肌酐正常范围的冠心病患者肾小球滤过率对冠状动脉（冠脉）侧支循环的影响及相关的危险因素。n　　方法：连续入选我院心内科导管室2013-05至2014-04行冠脉造影结果示严重血管狭窄（狭窄程度≥95%）且肌酐正常的患者194例。根据造影侧支循环Rentrop分级将患者分为冠脉侧支循环不充分组（Rentrop分级0~1级，共113例）和冠脉侧支循环充分组（Rentrop分级2~3级，共81例），记录患者的年龄、性别、既往史、血肌酐值、空腹血糖、血脂水平等，通过肾脏疾病膳食改良（MDRD）研究公式估测肾小球滤过率（eGFR），采用多因素Logistic回归模型分析冠脉侧支循环不充分与eGFR的相关性。n　　结果：在血清肌酐正常的范围内，eGFR水平在冠脉侧支循环不充分组较冠脉侧支循环充分组更低[（78.7±20.5） ml/（min·1.73 m2）vs（89.6±3.2）ml/（min·1.73 m2），P=0.012]，冠脉侧支循环不充分组的空腹血糖值[（7.5±3.4） mmol/L vs（6.7±2.8）mmol/L，P=0.003]、高敏C反应蛋白（hs-CRP）水平[（2.7±0.8）mg/L vs（2.3±0.6）mg/L， P=0.029]较冠脉侧支循环充分组更高，Gensini评分（7.7±3.9 vs 9.1±5.0，P=0.004）较冠脉侧支循环充分组更低，差异有统计学意义。多因素Logistic回归分析显示，eGFR（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评分（OR：0.98，95%CI：0.97~0.99，P<0.001）、空腹血糖（OR：1.21，95%CI：1.06~1.41， P=0.002）是冠脉侧支循环不充分的独立危险因素。n　　结论：肌酐正常范围内的冠心病患者肾小球滤过率是冠脉侧支循环不充分的重要预测因素。%Objective: To explore the impact of estimated glomerular ifltration rate (eGFR) on coronary collateral circulation (CCC) with its risk factors in coronary artery disease (CAD) patients with normal serum creatinine. n Methods: A total of 194 CAD patients with coronary stenosis≥95%having normal serum creatinine treated in our hospital from 2013-05 to 2014-04 were studied. According to the Rentrop scoring system, the patients were divided into 2 groups: Poor CCC group, the patients with Rentrop score at 0-1, n=113 and Sufifcient CCC group, the patients with Rentrop score at 2-3, n=81. The clinical information as age, gender, past history, serum creatinine level, fasting glucose and lipid were recorded at admission. The abbreviated modiifcation of diet in renal disease (MDRD) study equation was used to estimate eGFR. The relationship between Poor CCC occurrence and eGFR was evaluated by multivariate Logistic regression analysis. n Results: With the normal range of serum creatinine, compared with Sufifcient CCC group, the patients in Poor CCC group had decreased eGFR level (78.7 ± 20.5) ml/(min•1.73m2) vs (89.6 ± 3.2) ml/(min•1.73m2), P=0.012, increased fasting glucose level (7.5 ± 3.4) mmol/L vs (6.7 ± 2.8) mmol/L, P=0.003 and hs-CRP (2.7 ± 0.8) mg/ L vs (2.3 ± 0.6) mg/L, P=0.029;Poor CCC group had the lower Rentrop score, (7.7 ± 3.9) vs (9.1 ± 5.0), P=0.004. Multivariate logistic regression analysis presented that eGFR (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), Rentrop score (OR=0.98, 95% CI 0.97-0.99, P<0.001) and fasting glucose (OR=1.21, 95% CI 1.06-1.41, P=0.002) were the independent risk factors for poor CCC occurrence. n Conclusion: eGFR level is the important predictor of poor CCC occurrence in CAD patients with normal serum level of creatinine.