急性冠状动脉综合征患者介入术后1年肾功能变化及影响因素的分析

摘要

目的：探讨和分析可能影响冠状动脉介入术后1年的急性冠状动脉综合征（acute coronary syndrome，ACS）患者肾功能的因素及其作用。方法回顾了2013年1月至2013年9月以ACS诊断并收治于首都医科大学宣武医院心脏科并行冠状动脉介入治疗的287例患者的发病情况、临床资料及随访1年的资料。按照估算的肾小球滤过率（estimated glomerular filtration rate， eGFR）的变化情况将研究人群分为eGFR下降组（n＝155）和eGFR维持组（n＝132），应用Logistic多因素分析明确对患者肾功能产生影响的因素及作用。结果 eGFR下降组中高血压患者更多（67.4％ vs 55.5％），非ST段抬高的急性冠状动脉综合征的患者比例更高（58.3％ vs 42.6％）；两组患者在入院血红蛋白含量[（140.4±17.6）g／L vs [（140.2±14.3）g／L]，差异有统计学意义（F＝5.384，P＝0.020），在年龄、性别比例、糖尿病史、脑梗死病史、血脂、血糖、心肌酶、左心室射血分数、造影剂用量、冠状动脉病变血管支数以及支架置入数目方面比较，差异无统计学意义（P＞0.05）。Logistic分析结果表明，高血压病史以及急性冠状动脉综合征不同分型对于eGFR的下降具有独立的影响作用（P＝0.010，OR＝1.949，95％CI：1.174～3.237；P＝0.004，OR＝2.08，95％CI：1.265～3.418）。结论在接受了冠状动脉介入治疗的ACS患者中，具有高血压病史和非ST段抬高型急性冠状动脉综合征的患者在术后1年随访中发现eGFR降低的风险较高。%Objective To investigate the effect of possible influential factors on renal function among patients 1 year after coronary interventions.Methods Totally 287 patients with acute coronary syndrome (ACS)seen from Jan.201 3 to Sep.201 3 were enrolled in this retrospective study.All of them were treated with percutaneous coronary intervention (PCI)and followed up for at least 1 year.Then the clinical data were collected and analyzed retrospectively.The patients were divided into two groups according to the estimated glomerular filtration rate (eGFR)decreased or maintained after 1 year follow-up and a Logistic regression analysis was used to analyze the effect of influential factors.Results Compared with eGFR maintained group (n=1 32),hypertension (HTN)(67.4%vs 55.5%)and non-ST segment elevation ACS (NSTEACS)(58.3%vs 42.6%)were much common in eGFR decreased group (n=1 55)(P=0.02). There was a statistical significant difference in hemoglobin (HGB)(1 40.4 ±1 7.6g/L vs 1 40.2 ±1 4.3g/L;F=5.384,P=0.02)but no significant difference in age,gender,diabetes mellitus (DM),ischemic stroke (IS)history,cholesterol,glucose,myocardial enzymes, left ventricular ejection fraction (LVEF),dosage of contrast media,number of vessels with stenosis and number of stents implanted in one patient (P>0.05 )between the two groups.The Logistic analysis indicated that HTN and NSTEACS were independent risk factors to influence the eGFR (P=0.01 ,OR=1.949,95% CI:1.1 74-3.237 and P=0.004,OR=2.08,95%CI:1.265 -3.41 8).Conclusion For ACS patients who received PCI,those who had hypertension and NSTEACS were more likely to have decreased eGFR after 1 yearfollowup.