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冠心病是严重危害人类健康的慢性疾病之一,也是终末期肾病(ESRD)患者的严重合并症之一,同时也是尿毒症患者的主要死亡原因。国内有关统计资料显示,ESRD患者因心血管并发症致死的约占60％-70％。在美国ESRD患者中,40.8％合并冠心病,41.1％有心力衰竭病史。在维持性血液透析患者中因心血管事件死亡的危险性是普通人群的35倍。 慢性肾脏病患者不仅可合并严重高血压,脂质代谢异常,同时还存在特殊的冠心病危险因素,使尿毒症这组特殊人群发生冠心病的危险性显著高于普通人群及肾功能正常者,并且预后较没有肾脏疾病的冠心病患者差。随着血液透析技术的发展,尿毒症患者生存时间延长,缺血性心脏病的发生率也随之增加。心脏介入治疗的发展及临床应用,在冠心病普通人群中取得良好的长短期疗效,降低了病死率,改善了预后。但这种经皮冠状动脉介入治疗(PCI)方法能否在慢性肾脏病及尿毒症透析患者中进行,近期远期预后如何,值得在临床中进一步探讨。 导报邀请了卫生部北京医院肾内科吴华主任及北京安贞医院心肺血管疾病抢救中心颜红兵主任,共同讨论慢性肾脏病患者的介入治疗中存在的问题。
Coronary heart disease is one of the chronic diseases that seriously endanger human health and one of the serious complications of end-stage renal disease (ESRD). It is also the main cause of death in patients with uremia. Relevant domestic statistics show that ESRD patients die of cardiovascular complications account for about 60% -70%. In the United States ESRD patients, 40.8% of patients with coronary heart disease, 41.1% had a history of heart failure. The risk of death from cardiovascular events in maintenance hemodialysis patients is 35 times greater than in the general population. Patients with chronic kidney disease can not only be associated with severe hypertension, lipid metabolism, but there are also special risk factors for coronary heart disease, uremia this particular group of patients with coronary heart disease risk was significantly higher than the general population and normal renal function, And the prognosis than no coronary disease patients with poor kidney disease. With the development of hemodialysis technology, patients with uremia prolonged survival, the incidence of ischemic heart disease also increased. The development and clinical application of cardiac interventional therapy have achieved good short-term and long-term effects in the general population with coronary heart disease, reduced the case fatality rate and improved the prognosis. However, this percutaneous coronary intervention (PCI) in patients with chronic kidney disease and uremia dialysis patients, the recent long-term prognosis, it is worth further exploration in the clinic. Herald invites Wu Hua, director of Department of Nephrology, Beijing Hospital of Ministry of Health, and Yan Hongbing, director of the Cardiovascular Disease Relief Center of Beijing Anzhen Hospital, to discuss the problems in the interventional treatment of patients with chronic kidney disease.