慢性肾功能减退和贫血对经皮冠状动脉介入治疗预后的影响

目的 了解慢性肾功能减退和贫血对接受经皮冠状动脉(冠脉)介入治疗(PCI)的冠心病患者远期预后的影响.方法 2003年7月至2005年9月接受单纯PCI治疗并且术前有肾小球滤过率(GFR)和血红蛋白(Hb)资料的冠心病患者3770例.根据肾功能状况和是否贫血将患者分为6组:肾功能正常无贫血组2216例,有贫血组430例;肾功能轻度减退尤贫血组737例,有贫血组237例;肾功能中重度减退无贫血组80例,有贫血组70例.比较各组患者的临床特点、冠脉病变特点、住院期间用药情况以及术后病死率.结果各组患者在女性患者比例、年龄、入院时体重指数、高血压病史、糖尿病史、脑血管病史、急性冠脉综合征比例、收缩压、左室射血分数、总胆固醇、低密度脂蛋白胆固醇方面差异有统计学意义(P<0.01).在冠脉病变支数、冠脉开口病变比例、完全血管重建率方面差异有统计学意义(P<0.01).各组患者在陈旧性心肌梗死病史、血运重建史、住院期间β阻滞剂、阿司匹林、他汀类药物、血管紧张素转换酶抑制剂药物的使用率以及左主干和前降支近端病变方面差异无统计学意义(P>0.05).多因素Cox回归分析,GFR(HR 0.979,95%CI 0.960～0.999,P=0.035)和Hb(HR 0.952,95%CI 0.921～0.984,P=0.004)均是术后病死率的独立预测因素;肾功能轻度减退有贫血(HR 4.123,95%CI 1.637～10.386,P=0.003)、肾功能中重度减退无贫血(HR5.287,95%CI 1.627～17.183,P=0.006)、肾功能中重度减退有贫血(HR 7.134,95%CI 2.180～23.342,P=0.01)患者术后远期生存率显著降低.结论 GFR和Hb均是影响冠心病病死率的独立预测因素;不仅肾功能中重度减退且轻度减退合并贫血的患者,其PCI术后的远期生存率均显著降低.

Effects of chronic renal insufficiency and anemia upon long-term outcomes in patients undergoing percutaneous coronary intervention

Objective To assess whether chronic renal insufficiency and anemia are significant independent and combined predictors of poor long-term outcomes after percutaneous coronary intervention (PCI). Methods We examined the clinical and outcome data of 3770 PCI patients based on the pre-PCI values of glomerular filtration rate (GFR) and hemog/obin (Hb). Depending on their baseline GFR and Hb, the patients were classified into six groups: normal renal function with anemia or not; mild renal impairment with combined anemia or not; severe renal insufficiency with anemia or not. The clinical features and prognosis of patients were compared. Results Significant differences were found between the groups regarding female gender, age, body mass index, prior history of hypertension, diabetes mellitus, prior stroke, acute coronary syndrome, systolic blood pressure, left ventricular ejection fraction, total serum cholesterol, LDL-C and angiographic features ( P < 0.01). When evaluated as continuous variables, GFR and Hb were independent predictors of long-term mortality after adjusting for effects of each other ( GFR : HR 0. 979, 95% CI 0.960 - 0.999, P = 0.035 ; Hemoglobin : HR 0.952, 95 % CI 0.921 - 0.984, P =0.004 ). Mild renal insufficiency with anemia ( HR 4.123,95% CI 1.637 - 10.386, P = 0.003 ), severe renal insufficiency without anemia ( HR 5.287,95 % CI 1.627 - 17.183, P = 0.006) and severe renal insufficiency with anemia (HR 7.134,95% CI 2.180 -23.342,P =0.001 ) having a statistically significant decrease in survival in patients undergoing PCI . Conclusion Renal insufficiency and anemia are significant independent and combined predictors of long-term mortality in patients undergoing PCI.