尿微量白蛋白与冠状动脉病变的关系

目的 探讨尿微量白蛋白(MA)与冠状动脉(冠脉)病变的关系.方法 169例冠心病患者分为非糖尿病组99例,糖尿病组70例,均行冠脉造影(CAG),检测尿白蛋白/肌酐、尿素氮、肌酐、空腹血糖、2 h血糖、血脂等.冠脉病变程度通过病变血管数和冠脉病变积分两个指标表示.结果 (1)在非糖尿病组中,MA阳性组的冠脉病变积分(7.90±3.07比5.77±2.87,P＜0.05)和冠脉病变血管数(1.84±0.17比1.38±0.93,P＜0.05)明显高于MA阴性组.(2)在糖尿病组中,MA阳性组的冠脉病变积分(8.15±3.40比5.86±3.06,P＜0.05)和冠脉病变血管数(2.03±0.91比1.51±0.76,P＜0.05)明显高于MA阴性组.多元逐步回归分析示:男性、MA、LDL-C、射血分数是冠脉病变积分的独立预测因子.结论 筛查MA有助于发现冠脉病变严重的患者及疾病预后差的患者.

The relationship between microalbuminuria and coronary artery lesions

OBJECTIVE: To explore the relationship between microalbuminuria and the severity of coronary stenosis in patients with coronary heart disease. METHODS: 169 consecutive patients with coronary artery disease were divided into non-DM group and DM (diabetes mellitus) group. All the patients underwent coronary angiography (CAG) and echocardiography. Urinary albumin to creatinine ratio, BMI, serum creatinine, fasting blood glucose, 2-hour blood glucose, TC, LDL, HDL, TG etc were determined. The coronary artery changes were analysed with CAG. The severity of coronary artery lesion was evaluated by the numbers of diseased vessels and coronary artery stenosis score (6-step evaluation standard according to AHA). The risk factors of coronary artery lesion were analysed by stepwise multiple regression analysis. RESULTS: (1) In the non-DM group, a microalbuminuria (MA) subgroup had significantly higher coronary artery stenosis score and number of diseased vessels as compared with a non-MA subgroup (7.90 +/- 3.07 vs 5.77 +/- 2.87, P < 0.05; 1.84 +/- 0.17 vs 1.38 +/- 0.93, P < 0.05). Stepwise multiple regression analysis showed MA, male gender, LDL-C, EF were independent predictors of coronary artery stenosis score. (2) In the DM group, a MA subgroup also had significantly higher coronary artery stenosis score and number of diseased vessels as compared with a non-MA subgroup (8.15 +/- 3.4 vs 5.86 +/- 3.06, P < 0.05; 2.03 +/- 0.91 vs 1.51 +/- 0.76, P < 0.05). However, stepwise multiple regression analysis showed only MA and male gender were independent predictors of coronary artery stenosis score. CONCLUSION: The screening of MA in CHD helps to find out the patients with severe coronary artery lesion and worse prognosis.