估算肾小球滤过率对急性冠脉综合征患者重度冠状动脉病变预测价值
|
摘要
目的探讨估算肾小球滤过率(eGFR)对急性冠脉综合征(ACS)患者重度冠状动脉病变的预测价值。方法选取自2017年9月至2018年8月因ACS住院完善冠状动脉造影(CAG)检查的858例患者为研究对象。依据SYNTAX评分将所有患者分为冠状动脉正常(G_0)组(n=134)、轻度病变(G_1)组(n=536)、中度病变(G_2)组(n=105)、重度病变(G_3)组(n=83)。采用CKD-EPI2012肌酐-胱抑素C公式计算eGFR值。比较不同冠状动脉病变组间各临床指标的差异及相关性。采用Logistic有序回归分析分析分析冠状动脉病变严独立危险因素;两变量之间的相关性检验行Spearman相关分析;以受试者工作特性(ROC)曲线评价eGFR水平对重度冠状动脉病变的预测价值。结果各组患者eGFR水平比较,差异均有统计学意义(P<0.05)。Logistic有序回归分析结果提示,eGFR是冠状动脉病变严重程度的独立危险因素(P<0.05,95%可信区间-0.036～-0.016)。Spearman相关分析结果提示,eGFR与SYNTAX评分呈负相关(r=-2.78,P<0.05)。ROC曲线分析结果提示,eGFR预测重度冠脉病变的敏感度为0.66,特异度为0.65。结论 eGFR是冠状动脉病变严重程度的独立危险因素,与冠状动脉病变严重程度呈负相关。
Objective To investigate the predictive value of estimated glomerular filtration rate(eGFR)for severe coronary lesions in patients with acute coronary syndrome(ACS).Methods A retrospective study was performed on 858 cases of patients who underwent coronary arteriography(CAG)from September 2017 to August 2018.All patients were divided into coronary artery normal(G_0)group(n=134),mild lesion(G_1)group(n=536),moderate lesion(G_2)group(n=105)and severe lesion(G_3)group(n=83)according to SYNTAX score.CKD-EPI2012 creatinine-cystatin C formula was used to calculate eGFR.To compare the difference and correlation of clinical indexes between different coronary artery disease groups.Logistic regression analysis was used to analyze severe independent risk factors of coronary artery disease.Spearman correlation analysis was performed to test the correlation between the two variables.Objective operating characteristic(ROC)curves were used to evaluate the predictive value of eGFR level in severe coronary artery disease.Results There were significant differences in eGFR levels between groups(P<0.05).Multiple factors orderly logistic regression analysis suggested that eGFR was an independent risk factor for the severity and complexity of coronary artery disease(P<0.05,95%confidence interval-0.036～-0.016).Spearman correlation test showed that eGFR was positively associated with SYNTAX score(r=-2.78,P<0.05).The results of ROC curve analysis suggested that eGFR to predict severe coronary artery disease was with a sensitivity of 0.66 and a specificity of 0.65.Conclusion The eGFR is an independent risk factor for the severity of coronary arteries,and is negatively correlated with severity of coronary artery disease.
Objective To investigate the predictive value of estimated glomerular filtration rate(eGFR)for severe coronary lesions in patients with acute coronary syndrome(ACS).Methods A retrospective study was performed on 858 cases of patients who underwent coronary arteriography(CAG)from September 2017 to August 2018.All patients were divided into coronary artery normal(G_0)group(n=134),mild lesion(G_1)group(n=536),moderate lesion(G_2)group(n=105)and severe lesion(G_3)group(n=83)according to SYNTAX score.CKD-EPI2012 creatinine-cystatin C formula was used to calculate eGFR.To compare the difference and correlation of clinical indexes between different coronary artery disease groups.Logistic regression analysis was used to analyze severe independent risk factors of coronary artery disease.Spearman correlation analysis was performed to test the correlation between the two variables.Objective operating characteristic(ROC)curves were used to evaluate the predictive value of eGFR level in severe coronary artery disease.Results There were significant differences in eGFR levels between groups(P<0.05).Multiple factors orderly logistic regression analysis suggested that eGFR was an independent risk factor for the severity and complexity of coronary artery disease(P<0.05,95%confidence interval-0.036～-0.016).Spearman correlation test showed that eGFR was positively associated with SYNTAX score(r=-2.78,P<0.05).The results of ROC curve analysis suggested that eGFR to predict severe coronary artery disease was with a sensitivity of 0.66 and a specificity of 0.65.Conclusion The eGFR is an independent risk factor for the severity of coronary arteries,and is negatively correlated with severity of coronary artery disease.
引文
[1] Bansal N,Katz R,Robinson-Cohen C,et al.Absolute rates of heart failure,coronary heart disease,and stroke in chronic kidney disease:an analysis of 3 community-based cohort studies[J].JAMA Cardiol,2017,2(3):314-318.
[2] 申志祥,刘宇,刘敏,等.基于肌酐与胱抑素的肾小球滤过率估算方程对人群肾功能分期的评价及应用[J].中华流行病学杂志,2017,38(11):1557-1562.
[3] Sianos G,Morel MA,Kappetein AP,et al.The SYNTAX score:an angiographic tool grading the complexity of coronary artery disease[J].EuroIntervention,2005,1(2):219-227.
[4] Kappetein AP,Dawkins KD,Mohr FW,et al.Current percutaneous coronary intervention and coronary artery bypass grafting practices for three-vessel and left main coronary artery disease.Insights from the SYNTAX run-in phase[J].Eur J Cardiothorac Surg,2006,29(4):486-491.
[5] Mohr FW,Morice MC,Kappetein AP,et al.Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease:5-year follow-up of the randomised,clinical SYNTAX trial[J].Lancet,2013,381(9867):629-638.
[6] 中华医学会心血管病学分会介入心脏病学组,中国医师协会心血管内科医师分会血栓防治专业委员会,中华心血管病杂志编辑委员会等.中国经皮冠状动脉介入治疗指南(2016)[J].中华心血管病杂志,2016,44(5):382-400.
[7] Vroegindewey MM,Schuurman AS,Kardys I,et al.SYNTAX score in relation to intravascular ultrasound and near-infrared spectroscopy for the assessment of atherosclerotic burden in patients with coronary artery disease[J].Euro Intervention,2019,14(13):1408-1415.
[8] Inker LA,Schmid CH,Tighiouart H,et al.Estimating glomerular filtration rate from serum creatinine and cystatin C[J].N Engl J Med,2012,367(1):20-29.
[9] 刘国保,黎蕾,华余强,等.轻-中度慢性肾功能不全与冠状动脉病变的相关性研究[J].中国CT和MRI杂志,2018,16(11):79-82.
[10] Wanner C.Prevention of cardiovascular disease in chronic kidney disease patients[J].Semin Nephrol,2009,29(1):24-29.
[11] Moe SM,Chen NX.Pathophysiology of vascular calcification in chronic kidney disease[J].Circ Res,2004,95(6):560-567.
[12] Mohandas R,Segal MS,Huo T,et al.Renal function and coronary microvascular dysfunction in women with symptoms/signs of ischemia[J].PLoS One,2015,10(5):e0125374.
[13] Edwards NC,Moody WE,Yuan M,et al.Diffuse interstitial fibrosis and myocardial dysfunction in early chronic kidney disease.Am J Cardiol,2015,115(9):1311-1317.
[14] Ix JH,Shlipak MG,Chertow GM,et al.Association of cystatin C with mortality,cardiovascular events,and incident heart failure among persons with coronary heart disease:data from the Heart and Soul Study[J].Circulation,2007,115(2):173-179.
[2] 申志祥,刘宇,刘敏,等.基于肌酐与胱抑素的肾小球滤过率估算方程对人群肾功能分期的评价及应用[J].中华流行病学杂志,2017,38(11):1557-1562.
[3] Sianos G,Morel MA,Kappetein AP,et al.The SYNTAX score:an angiographic tool grading the complexity of coronary artery disease[J].EuroIntervention,2005,1(2):219-227.
[4] Kappetein AP,Dawkins KD,Mohr FW,et al.Current percutaneous coronary intervention and coronary artery bypass grafting practices for three-vessel and left main coronary artery disease.Insights from the SYNTAX run-in phase[J].Eur J Cardiothorac Surg,2006,29(4):486-491.
[5] Mohr FW,Morice MC,Kappetein AP,et al.Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease:5-year follow-up of the randomised,clinical SYNTAX trial[J].Lancet,2013,381(9867):629-638.
[6] 中华医学会心血管病学分会介入心脏病学组,中国医师协会心血管内科医师分会血栓防治专业委员会,中华心血管病杂志编辑委员会等.中国经皮冠状动脉介入治疗指南(2016)[J].中华心血管病杂志,2016,44(5):382-400.
[7] Vroegindewey MM,Schuurman AS,Kardys I,et al.SYNTAX score in relation to intravascular ultrasound and near-infrared spectroscopy for the assessment of atherosclerotic burden in patients with coronary artery disease[J].Euro Intervention,2019,14(13):1408-1415.
[8] Inker LA,Schmid CH,Tighiouart H,et al.Estimating glomerular filtration rate from serum creatinine and cystatin C[J].N Engl J Med,2012,367(1):20-29.
[9] 刘国保,黎蕾,华余强,等.轻-中度慢性肾功能不全与冠状动脉病变的相关性研究[J].中国CT和MRI杂志,2018,16(11):79-82.
[10] Wanner C.Prevention of cardiovascular disease in chronic kidney disease patients[J].Semin Nephrol,2009,29(1):24-29.
[11] Moe SM,Chen NX.Pathophysiology of vascular calcification in chronic kidney disease[J].Circ Res,2004,95(6):560-567.
[12] Mohandas R,Segal MS,Huo T,et al.Renal function and coronary microvascular dysfunction in women with symptoms/signs of ischemia[J].PLoS One,2015,10(5):e0125374.
[13] Edwards NC,Moody WE,Yuan M,et al.Diffuse interstitial fibrosis and myocardial dysfunction in early chronic kidney disease.Am J Cardiol,2015,115(9):1311-1317.
[14] Ix JH,Shlipak MG,Chertow GM,et al.Association of cystatin C with mortality,cardiovascular events,and incident heart failure among persons with coronary heart disease:data from the Heart and Soul Study[J].Circulation,2007,115(2):173-179.