论著

肾小球滤过率与冠状动脉支架内再狭窄的相关性分析

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  • 1.上海交通大学医学院附属瑞金医院心内科,上海200025
    2.上海交通大学医学院附属第九人民医院心内科,上海200011

收稿日期: 2020-04-25

  网络出版日期: 2020-06-25

基金资助

上海交通大学医工交叉课题(YG2013MS31);中华医学会2014高胆固醇研究课题(14010120549)

Correlation of estimated glomerular filtration rate with incidence of in-stent restenosis in patients with drug-elu-ting stent

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  • 1. Department of Cardiology, Rujin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    2. Department of Cardiology,Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China

Received date: 2020-04-25

  Online published: 2020-06-25

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。

本文引用格式

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 . DOI: 10.16150/j.1671-2870.2020.03.017

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.

参考文献

[1] Ene-Iordache B, Perico N, Bikbov B, et al. Chronic kidney disease and cardiovascular risk in six regions of the world (ISN-KDDC): A cross-sectional study[J]. Lancet Glob Health, 2016, 4(5):e307-e319.
[2] Mathew RO, Bangalore S, Lavelle MP, et al. Diagnosis and management of atherosclerotic cardiovascular di-sease in chronic kidney disease: A review[J]. Kidney int, 2017, 91(4):797-807.
[3] Keith DS, Nichols GA, Gullion CM, et al. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization[J]. Arch Intern Med, 2004, 164(6):659-663.
[4] Zhang L, Zhao MH, Zuo L, et al. China Kidney Disease Network (CK-NET) 2015 Annual Data Report[J]. Kidney Int Suppl, 2019, 9(1):e1-e81.
[5] 国家心血管病中心. 中国心血管病报告2018[M]. 北京: 中国大百科全书出版社, 2018.
[6] Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: A cross-sectional survey[J]. Lancet, 2012, 379(9818):815-822.
[7] Zhang L, Wang H, Long J, et al. China Kidney Disease Network (CK-NET) 2014 Annual Data Report[J]. Am J kidney Dis, 2017, 69(6S2):A4.
[8] Ishimoto Y, Tanaka T, Yoshida Y, et al. Physiological and pathophysiological role of reactive oxygen species and reactive nitrogen species in the kidney[J]. Clin Exp Pharmacol Physiol, 2018, 45(11)1097-1105.
[9] Spoto B, Pisano A, Zoccali C, et al. Insulin resistance in chronic kidney disease: a systematic review[J]. Am J Physiol Renal Physiol, 2016, 311(6):F1087-F1108.
[10] Horowitz B, Miskulin D, Zager P, et al. Epidemiology of hypertension in CKD[J]. Adv Chronic Kidney Dis, 2015, 22(2):88-95.
[11] 王芳, 章安迪. 伴有多种危险因素的冠心病患者支架内再狭窄的影响因素[J]. 诊断学理论与实践, 2016, 15(3):280-282.
[12] Welt FG, Rogers C. Inflammation and restenosis in the stent era[J]. Arterioscler Thromb Vasc Biol, 2002, 22(11):1769-1776.
[13] Gross ML, Meyer HP, Ziebart H, et al. Calcification of coronary intima and media: Immunohistochemistry, backscatter imaging, and X-ray analysis in renal and nonrenal patients[J]. Clin J Am Soc Nephrol, 2007, 2(1):121-134.
[14] Ishibashi M, Hiasa K, Zhao Q, et al. Critical role of monocyte chemoattractant protein-1 receptor CCR2 on monocytes in hypertension-induced vascular inflammation and remodeling[J]. Circ Res, 2004, 94(9):1203-1210.
[15] 张瑞岩, 慢性肾病对冠心病发病和预后的影响[J]. 内科理论与实践, 2006, 3(2):94-98.
[16] Kaul U, Bhagwat A, Pinto B, et al. Paclitaxel-eluting stents versus everolimus-eluting coronary stents in a diabetic population: Two-year follow-up of the TUXEDO-India trial[J]. EuroIntervention, 2017, 13(10):1194-1201.
[17] Sedlis PS, Jurkovitz CT, Hartigan PM, et al. Optimal medical therapy with or without percutaneous coronary intervention for patients with stable coronary artery disease and chronic kidney disease[J]. Am J Cardiol, 2009, 104(12):1647-1653.
[18] Khalique O, Aronow WS, Ahn C, et al. Relation of moderate or severe reduction in glomerular filtration rate to number of coronary arteries narrowed >50% in patients undergoing coronary angiography for suspected coronary artery disease[J]. Am J Cardiol, 2007, 100(3):415-416.
[19] Rostand SG, Gretes JC, Kirk KA, et al. Ischemic heart disease in patients with uremia undergoing maintenance hemodialysis[J]. Kidney Int, 1979, 16(5):600-611.
[20] Schwarz U, Buzello M, Ritzet E, et al. Morphology of coronary atherosclerotic lesions in patients with end-stage renal failure[J]. Nephrol Dial Transplant, 2000, 15(2):218-223.
[21] 曹立秀, 张欢, 肖华, 等. 中-重度肾功能不全患者冠状动脉病变的CT诊断研究[J]. 诊断学理论与实践, 2011, 10(6):523-526.
[22] Kato K, Yonetsu T, Jia H, et al. Nonculprit coronary plaque characteristics of chronic kidney disease[J]. Circ Cardiovasc imaging, 2013, 6(3):448-456.
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