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目的观察肾小球滤过率(glomerular filtration rate,GFR)与急性心肌梗死(acute myocardial infarction,AMI)患者冠状动脉狭窄程度及住院期间发生心源性死亡之间的关系。评估肾功能对AMI患者冠状动脉狭窄严重程度及近期预后的影响。方法 286例AMI患者分为肾功能正常组[肾小球滤过虑估计值(eGFR)≥90 ml/(min·1.73 m2)]及轻度减退组[60 ml/(min·1.73 m2)≤eGFR<90 ml/(min·1.73 m2)]及中重度减退组[eGFR<60 ml/(min·1.73 m2)],根据冠状动脉造影后病变支数分为A、B、C3组,分别比较3组患者病变狭窄程度,进一步行多因素Logistic回归分析方法评估肾功能对AMI患者近期预后的影响。结果随着冠脉病变支数增加GFR降低,比较3组传统心血管危险因素及狭窄程度的差异发现,3组之间年龄、总胆固醇(cholesterol,TC)、低密度脂蛋白(low-density lipoprotein,LDL)、积分差异有统计学意义(P<0.001)。入院时GFR水平、性别、高血压病史、糖尿病病史、甘油三酯(triglycerides,TG)、高密度脂蛋白(high-density lipoprotein,HDL)是AMI患者住院期间发生心源性死亡的独立预测因子。结论 AMI患者入院时GFR减低预示冠状动脉血管狭窄程度较重,住院期间发生心源性死亡的可能性较大。
Objective To investigate the relationship between glomerular filtration rate (GFR) and coronary artery stenosis and cardiac death during hospitalization in patients with acute myocardial infarction (AMI). To evaluate the effect of renal function on the severity of coronary artery stenosis and its prognosis in AMI patients. Methods A total of 286 patients with AMI were divided into three groups: normal renal function group (estimated glomerular filtration rate ≥90 ml / (min · 1.73 m2)] and mild hypothyroidism group [60 ml / (min · 1.73 m2) ≤eGFR <90 ml / (min · 1.73 m2)] and moderate-severe hypothyroidism group [eGFR <60 ml / (min · 1.73 m2)] were divided into A, B and C3 groups according to the number of lesions after coronary angiography Group patients with stenosis, further multivariate Logistic regression analysis of renal function to assess the short-term prognosis of patients with AMI. Results The GFR decreased with the increase of coronary lesions. Compared with the traditional cardiovascular risk factors and the degree of stenosis in the three groups, it was found that age, total cholesterol (TC), low-density lipoprotein , LDL), the difference was statistically significant (P <0.001). GFR levels, gender, history of hypertension, history of diabetes mellitus, triglycerides (TG), and high-density lipoprotein (HDL) at admission were independent predictors of cardiac death during AMI. Conclusions The decrease of GFR on admission in AMI indicates that coronary artery stenosis is serious, and the possibility of cardiac death during hospitalization is high.