急性冠状动脉综合征合并高血压患者PCI术后1年肾功能变化及影响因素分析

摘要

目的 分析急性冠状动脉综合征(ACS)合并高血压患者经皮冠状动脉介入(PCI)术后1年肾功能的变化及影响因素.方法 选取包括ST段抬高型、非ST段抬高型ACS合并高血压患者150例,均于PCI术后1年取得随访.根据PCI术后1年肾小球滤过率(eGFR)变化情况患者分为eGFR下降组(n=82)和eGFR维持组(n=68),统计和分析两组人口统计学资料、合并疾病、实验室指标、介入情况等差异,并进行Logistic单因素回归分析.结果 eGFR下降组年龄及舒张压、收缩压、血尿酸水平显著高于eGFR维持组,两组比较差异均有统计学意义(均P＜ 0.05),eGFR下降组肾功能受损史、ST段抬高型ACS、急诊PCI患者例数显著较eGFR维持组多,两组比较差异均有统计学意义(均P＜0.05),两组其余临床资料及手术资料比较差异均无统计学意义(均P＞ 0.05).单因素非条件Logistic回归分析结果显示高龄、高舒张压和收缩压水平、肾功能受损史、ST段抬高型ACS、高血尿酸水平、急诊PCI与PCI术后1年肾功能变化具有显著相关性(P＜0.05).结论 ACS合并高血压PCI术后极易发生肾功能损伤,其危险因素包括高龄、高舒张压和收缩压水平、肾功能受损史、ST段抬高型ACS、高血尿酸水平、急诊PCI.%Objective To analyze the change of renal function and its influencing factors in patients with acute coronary syndrome (ACS) complicated with hypertension within 1 year after percutaneous coronary intervention (PCI).Methods A total of 150 cases of ST segment elevation or non-ST segment elevation ACS complicated with hypertension were enrolled in the study.All patients were followed up for 1 year after PCI.According to the change of glomerular filtration rate (eGFR) 1 year after PCI,the subjects were divided into eGFR decrease group (n=82) and eGFR maintenance group (n=68).The differences in demographic data,complications,laboratory indicators,and intervention between the two groups were statistically analyzed,and univariate Logistic regression analysis was performed.Results Age,diastolic blood pressure,systolic blood pressure,and blood uric acid levels in the eGFR decrease group were significantly higher than those in the eGFR maintenance group (P＜0.05).Patients with history of renal function damage,ST segment elevation ACS,and emergency PCI in the eGFR decrease group were significantly more than those in the eGFR maintenance group (P＜0.05).There were no statistically significant differences in the other clinical data or surgical data between the two groups (P＞0.05).Non-conditional Logistic regression analysis showed that advanced age,high diastolic and systolic blood pressure,history of renal function damage,ST segment elevation ACS,high blood uric acid level,and emergency PCI were significantly correlated with change of renal function within 1 year after PCI (P＜0.05).Conclusions Patients with ACS complicated with hypertension are prone to have renal function damage after PCI,and the risk factors include advanced age,high diastolic and systolic blood pressure,history of renal function damage,ST segment elevation ACS,high blood uric acid level,and emergency PCI.