肾小球滤过率与冠状动脉支架内再狭窄的相关性分析

doi:10.16150/j.1671-2870.2020.03.017

摘要/Abstract

摘要：

目的： 探索冠状动脉（冠脉）药物洗脱支架植入（以下简称支架植入）术后随访期估算肾小球滤过率（estimated glomerular filtration rate, eGFR）与支架植入术后再狭窄（in-stent restenosis, ISR）间的关系。方法： 以中国冠状动脉斑块进展多因素回顾分析研究中的患者为对象,病例均于2010年1月至2016年7月间在各中心进行冠脉造影检查,并在之后12~24个月（平均为13个月）内进行冠脉造影复查,采用二元Logistics回归分析评估随访期eGFR与ISR间的关系,初步探索导致ISR发生的危险因素。结果： 本研究共纳入符合标准的冠心病患者1 790例,随访期全体患者eGFR平均值为89.97 mL/（min·1.73m²）,按照随访期复查冠脉造影有无ISR,分为ISR组（n=200）和无ISR组（n=1590）。其中,ISR组患者在随访期间的eGFR低于无ISR组[（86.50±25.69） mL/（min·1.73 m²）比（90.64±26.59） mL/（min·1.73 m²）,P=0.038]。二元Logistics回归分析提示,导致ISR的危险因素包括植入支架的个数（OR=1.478, 95% CI 1.177~1.855, P=0.001）、基线期C反应蛋白升高（OR=1.006, 95%CI 1.002~1.011, P=0.007）,而随访期间相对较高的eGFR是ISR的保护性因素（OR=0.990,95%CI 0.982~0.999, P=0.022）。结论： 在eGFR基本正常的冠心病患者中,较低的随访期eGFR水平与其接受冠脉药物洗脱支架植入术后的ISR发生率密切相关。

关键词: 肾小球滤过率, 药物洗脱支架, 再狭窄, Logistics回归

Abstract:

Objective: To evaluate correlation of estimated glomerular filtration rate with occurrence of in-stent restenosis (ISR) in patients treated with drug-eluting stent(DES) implantation during follow-up period. Methods: Patients undergone DES implantation in the RIPPER study between January 2010 and July 2016 were enrolled, and coronary angiography was performed again to detect ISR after 12-24 months (with the average time of 13 months). Binary Logistics regression were used to assess the risk factors for in-stent restenosis (ISR), and evaluate the correlation of eGFR with ISR in patients. Results: A total of 1 790 patients meeting the inclusion criteria, with the average eGFR of 89.97 mL/(min·1.73 m²) during follow-up, were divided into ISR group (n=200) and No-ISR group (n=1 590). The eGFR in ISR group was significantly lower than No-ISR group [(86.50±25.69) mL/(min·1.73 m²) vs. (90.64±26.59) mL/(min·1.73 m²), P=0.038]. Binary Logistics regression showed that the risk factors for ISR were number of implanted stent[OR=1.478, 95% CI 1.177-1.855, P=0.001] and increased baseline C-reactive protein level [OR=1.006, 95%CI 1.002-1.011, P=0.007], while relatively elevated eGFR during follow-up was protective factor（OR=0.990, 95%CI 0.982-0.999, P=0.022.Conclusions: In patients with nearly normal eGFR after DES implantation, relatively lower eGFR is correlated with the incidence of ISR.

Key words: Estimated glomerular filtration rate, Drug eluting stent, Restenosis, Logistics regression

中图分类号:

R541.4

刘圣均, 刘莉莉, 朱政斌, 孙宜, 朱天奇, 冯硕, 陈馨, 权薇薇, 张瑞岩. 肾小球滤过率与冠状动脉支架内再狭窄的相关性分析[J]. 诊断学理论与实践, 2020, 19(03): 297-302.

LIU Shengjun, LIU Lili, ZHU Zhengbin, SUN Yi, ZHU Tianqi, FENG Shuo, CHEN Xin, QUAN Weiwei, ZHANG Ruiyan. Correlation of estimated glomerular filtration rate with incidence of in-stent restenosis in patients with drug-elu-ting stent[J]. Journal of Diagnostics Concepts & Practice, 2020, 19(03): 297-302.

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项目	无ISR组(n=1 590)	ISR组(n=200)	P值
临床特征
年龄（岁）	63.45±10.79	63.09±10.15	0.658
男性 [n(%）]	1 169(73.5%)	147(73.5%)	0.995
体质量指数（kg/m²）	25.46±3.22	25.49±3.4	0.919
基线期收缩压（mmHg）	131.48±17.46	130.82±16.61	0.613
基线期舒张压（mmHg）	78.15±10.62	77.5±10.81	0.415
随访期收缩压（mmHg）	130.11±15.24	131.27±16.82	0.316
随访期舒张压（mmHg）	77.29±9.60	77.51±10.42	0.758
基线期射血分数（%）	61.59±8.36	62.17±7.72	0.366
随访期射血分数（%）	61.94±8.02	61.27±8.75	0.287
冠脉造影信息
2次造影间隔时间（d）	446.75±102.06	456.87±100.70	0.186
植入支架数^*（个）	1 (1~2)	1 (1~2)	0.006
平均支架长度（mm）	26.0 (19.8~33.4)	28.0 (20.9~34.9)	0.171
合并症
高血压[n（%）]	1 017(64.0%)	135(64.0%)	0.325
糖尿病[n（%）]	908(57.1%)	112(57.1%)	0.766
高脂血症[n（%）]	241(15.2%)	35(15.2%)	0.387
慢性肾病病史[n（%）]	31(1.9%)	3(1.9%)	0.661
急性冠脉综合征病史[n（%）]	267(16.8%)	41(16.8%)	0.190
外周血管病史[n（%）]	128(8.1%)	15(8.1%)	0.787
卒中病史[n（%）]	87(5.5%)	16(5.5%)	0.148
吸烟史[n（%）]	674(42.4%)	89(42.4%)	0.570
药物治疗
P2Y12受体拮抗剂使用 [n（%）]	1 526(96.0%)	190(96.0%)	0.514
降脂药使用[n（%）]	1 538(96.7%)	193(96.7%)	0.864
ACEI和（或）ARB使用[n（%）]	911(57.3%)	114(57.3%)	0.937
β受体阻滞剂使用[n（%）]	1 162(73.1%)	144(73.1%)	0.745

项目	基线期			随访期
项目	无ISR组	ISR组	P值	无ISR组	ISR组	P值
肾功能相关指标
尿酸（μmol/L）	335.97±96.20	334.12±97.49	P>0.05	334.12±97.49	337.95±91.21	P>0.05
eGFR[mL/(min·1.73 m²)]	91.53±27.53	88.10±26.27	P<0.05	88.10±26.27	86.50±25.69	P<0.05
其他实验室指标
C反应蛋白（mg/L）	1.6(0.7~5.1)	2.6(0.8~8.5)	P>0.05	2.6(0.8~8.5)	0.9(0.5~2.5)	P>0.05
空腹血糖（mmol/L）	6.19±2.36	6.53±3.16	P>0.05	6.53±3.16	6.19±2.26	P>0.05
总胆固醇（mmol/L）	4.25±1.20	4.19±1.14	P>0.05	4.19±1.14	3.64±0.87	P>0.05
甘油三酯（mmol/L）	1.84±1.30	1.72±1.14	P>0.05	1.72±1.14	1.59±1.24	P>0.05
高密度脂蛋白胆固醇（mmol/L）	1.05±0.29	1.07±0.28	P>0.05	1.07±0.28	1.08±0.31	P>0.05
低密度脂蛋白胆固醇（mmol/L）	2.50±0.93	2.44±0.86	P>0.05	2.44±0.86	2.01±0.68	P>0.05

项目	单因素分析	多因素分析
项目	P值	β值	P值	OR(95% CI)
性别(男性) [n(%）]	0.995	-0.163	0.379	0.850(0.592~1.221)
年龄（岁）	0.658	-0.024	<0.001	0.976(0.968~0.984)
糖尿病 [n（%）]	0.766	-0.162	0.324	0.851(0.617~1.173)
吸烟史 [n（%）]	0.570	0.070	0.673	1.073(0.773~1.489)
植入支架数（个）	0.006	0.391	0.001	1.478(1.177~1.855)
基线空腹血糖（mmol/L）	0.080	0.042	0.174	1.043(0.982~1.108)
基线期C反应蛋白（mg/L）	0.064	0.006	0.007	1.006(1.002~1.011)
基线期eGFR[mL/(min·1.73 m²)]	0.097	-0.004	0.363	0.996(0.988~1.004)
随访期eGFR（mL/(min·1.73 m²)）	0.038	-0.010	0.022	0.990(0.982~0.999)