摘要
目的 比较不同时期介入治疗对不同肾功能水平的非ST段抬高急性冠脉综合征（NSTEACS）患者预后的影响.方法 将2007年4月至2008年7月入选NSTEACS患者815例分为早期介入组（〈24 h）和延迟介入组（〉36 h）,其中781例患者入选时测定过血清肌酐（Scr）,通过MDRD简化公式计算肾小球滤过率（eGFR）,并按照肾功能正常eGFR≥90 ml·min^-1（1.73 m^2）^-1,轻度肾功能异常60≤eGFR〈90 ml·min^-1·（1.73 m^2）^-1,中度以上肾功能不全eGFR〈60 ml·min^-1·（1.73 m^2）^-1进行分组.随访180 d,比较主要联合终点事件死亡,心肌梗死,卒中的发生情况.结果 3组[eGFR≥90 ml·min^-1·（1.73 m^2）^-1;60 ml·min^-1·（1.73 m^2）^-1≥eGFR〈90ml·min^-1·（1.73 m^2）^-1;eGFR〈60 ml·min^-1·（1.73 m^2）^-1]主要联合终点事件发生率分别为6.3%、10.1%和15.5%（P=0.032）;病死率分别为1.9%;2.6%和9.1%（P〈0.01）.Logistic单因素及多因素回归分析3组患者早期介入与延迟介入的联合终点事件,调整基线等因素后,60≤eGFR〈90 ml·min^-1·（1.73 m^2）^-1的患者延迟介入比早期介入风险增加（OR 2.106 95%CI 1.102～4.024P=0.024）.结论 早期介入治疗对轻度肾功能不全的患者可减少180 d联合终点事件死亡、心肌梗死、卒中的发生.
Objective To investigate the effects of intervention treatment in relation to renal function in patients with non-ST segment elevation acute coronary syndrome（NSTEACS）.Methods A total of 815 NSTEACS patients were randomized to receive either early intervention （coronary angiography within 24 h of randomization） or delayed intervention （coronary angiography over 36 h after randomization）.Serum creatinine was determined in 781 patients at admission and glomerular filtration rate （eGFR） calculated by the abbreviated MDRD formula.The subjects were stratified according to eGFR ≥ 90 ml· min^-1·（1.73m^2）^-1,60≤eGFR 〈90 ml·min^-1·（1.73 m^2）^-1 and eGFR 〈60 ml·min^-1·（1.73 m^2）^-1 and followed up for 180 days.Death,myocardial infarction or stroke was regarded as the primary end point.Results Incidence of the primary end point was 6.3% at eGFR ≥ 90 ml·min^-1 （1.73 m^2）^-1,10.1% at60≤eGFR〈90 ml· min^-1·（1.73 m^2）^-1 and 15.5% at eGFR〈60 ml·min^-1·（1.73m^2）^-1 （P=0.032） .The 180 day mortality was 1.9% at eGFR ≥ 90 ml·min^-1 （1.73 m^2）^-1,2.6% at 60≤ eGFR 〈 90 ml·min^-1·（1.73 m^2）^-1 and 9.1% at eGFR 〈 60 ml·min^-1·（1.73 m^2）^-1 （P= 0.01） In a logistic regression analysis,adjusting for other important covariables,the delayed intervention remained independently associated with the risk of primary end point in 60≤eGFR 〈90 ml·min^-1·（1.73m^2）^-1 group （odds ratio,2.106;95% confidence interval,1.102-4.024）.Conclusion The strategy of early intervention reduces the risk of death/MI or stroke at 180 days in NSTEACS patients with mild renal dysfunction.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2010年第34期2380-2384,共5页
National Medical Journal of China
关键词
冠脉动脉硬化
肾小球滤过率
肾功能衰竭
Coronary arteriosclerosis
Glomerular filtration rute
Kidney failure
