摘要目的 分析中老年人慢性肾功能不全与冠状动脉(冠脉)病变复杂程度的相关性. 方法 前瞻性连续性收集2011年1月至2012年6月于我院初次行冠脉造影并确诊为冠心病的患者1380例,根据美国心脏病学会及美国心脏协会冠状动脉病变分型系统将冠脉病变患者分为A、B1、B2及C型.运用简化的MDRD公式计算肾小球滤过率(eGFR),根据eGFR值分为肾功能正常组234例(eGFR≥90 ml· min-1·1.73 m-2),肾功能轻度减退组881例(eGFR 60～89 ml·min-1·1.73m-2),肾功能中重度减退组265例(eGFR＜60 ml· min-1·1.73 m-2).通过有序Logistic回归分析慢性肾功能不全与冠脉病变复杂程度的相关性. 结果 与肾功能正常组比较,肾功能轻度减退组、中重度减退组患者年龄较大(F=56.82,P＜0.001),女性患者比例高(x2=66.29,P＜0.001),高血压(x2=17.57,P＜0.001)、糖尿病(x2=20.97,P＜0.001)、高脂血症患病率高(x2=10.48,P=0.005).肾功能轻度减退组及中重度减退组冠脉B2及C型病变的比例较肾功能正常组高(x2=175.03,P＜0.001).有序Logistic回归分析表明年龄、高血压、糖尿病、C-反应蛋白及eGFR是冠脉病变分型的独立危险因素. 结论 年龄、高血压、糖尿病、C-反应蛋白以及eGFR是冠脉病变复杂程度的独立危险因素.

abstractsObjective To investigate the association between chronic kidney dysfunction and the complexity of coronary artery disease in elderly patients.Methods A prospective study was conducted on 1380 consecutive patients underwent coronary angiography for the first time in our hospital and with angiographically diagnosed coronary artery disease from January 2011 to June 2012.The complexity of coronary artery disease were classified according to the American College of Cardiology/American Heart Association (ACC/AHA) grading system as types A,B1,B2,and C.Estimated glomerular filtration rate (eGFR) was calculated by the simplified Modification of Diet in Renal Disease(MDRD)equation.Patients were classified into 3 stages according to eGFR as follows:normal renalfunction(n=234,eGFR≥90 ml· min-1 · 1.73 m-2),mild renaldysfunction(n=881,60≤eGFR＜90 ml · min-1 · 1.73 m-2,and moderate or severe renaldysfunction(n=265,eGFR＜60ml · min-1 · 1.73 m-2).Ordinal logistic regression was used to analyze the association between chronic kidney dysfunction and the complexity of coronary artery disease.Results Patients with mild,moderate or severe renal dysfunction were older (F=56.82,P＜0.001),more predominantly female (x2 =66.29,P＜ 0.001) and more likely to have history of hypertension (x2 =17.57,P ＜ 0.001),diabetes (x2=20.97,P＜0.001) and hyperlipidemia (x2=10.48,P 0.005) than those with normal renal function.The percentage of lesions of types B2 or C in moderate or severe renal dysfunction group was higher than that in normal renal function group (x2=175.03,P＜0.001).The ordinal logistic regression showed that age,male,hypertension,diabetes,C-reactive protein and eGFR were independent risk factors for the ACC/AHA lesion classification.Conclusions Age,male,hypertension,diabetes,C-reactive protein and eGFR are independent risk factors for the complexity of coronary artery disease.