Marso S P, Ellis S G, Gurm H S, Lytle B W, Topol E J
Department of Cardiology, The Cleveland Clinic Foundation, OH, USA.
Am Heart J. 2000 Jun;139(6):939-44. doi: 10.1067/mhj.2000.105699.
Proteinuria is a marker for underlying diabetic nephropathy and may be a surrogate marker for advanced atherosclerosis. It is unknown if proteinuria is a determinant of death in patients with diabetes after coronary artery bypass grafting. We hypothesized that diabetic patients with evidence of proteinuria would have increased mortality and clinical event rates after isolated coronary artery bypass grafting compared with nonproteinuric diabetic patients.
We performed an observational of study of 905 diabetic patients with urinalysis and available follow-up data (nonproteinuria, n = 651; proteinuria, n = 254) after isolated coronary artery bypass grafting at the Cleveland Clinic Foundation between January 1989 and December 1992. The proteinuria group was further prospectively stratified into low-concentration (n = 225) and high-concentration (n = 29) groups. The end points of this study were all-cause mortality and the composite end point of death, nonfatal myocardial infarction, and need for repeat revascularization. The mean follow-up time was 66 months. The 5-year mortality rate for the nonproteinuria and proteinuria groups was 20.2% and 29.1% (P <.001), respectively. The 5-year rate of death, nonfatal myocardial infarction, and need for repeat revascularization for the nonproteinuria and proteinuria groups was 25.2% and 36.2% (P <.001), respectively. Significant multivariate predictors of 5-year mortality included age, not using a left internal mammary artery graft to the left anterior descending coronary artery, proteinuria, lower body weight, and increased creatinine level.
Among diabetic patients, proteinuria appears to be an important predictor of death after isolated coronary artery bypass grafting.
蛋白尿是潜在糖尿病肾病的一个标志物，也可能是晚期动脉粥样硬化的替代标志物。目前尚不清楚蛋白尿是否是冠状动脉搭桥术后糖尿病患者死亡的一个决定因素。我们假设，与无蛋白尿的糖尿病患者相比，有蛋白尿证据的糖尿病患者在单纯冠状动脉搭桥术后的死亡率和临床事件发生率会增加。
我们对1989年1月至1992年12月在克利夫兰诊所基金会接受单纯冠状动脉搭桥术的905例糖尿病患者进行了一项观察性研究，这些患者均有尿液分析及可用的随访数据（无蛋白尿组，n = 651；蛋白尿组，n = 254）。蛋白尿组进一步前瞻性地分为低浓度组（n = 225）和高浓度组（n = 29）。本研究的终点为全因死亡率以及死亡、非致命性心肌梗死和再次血运重建需求的复合终点。平均随访时间为66个月。无蛋白尿组和蛋白尿组的5年死亡率分别为20.2%和29.1%（P <.001）。无蛋白尿组和蛋白尿组的5年死亡、非致命性心肌梗死及再次血运重建需求发生率分别为25.2%和36.2%（P <.001）。5年死亡率的显著多变量预测因素包括年龄、未使用左乳内动脉移植至左前降支冠状动脉、蛋白尿、较低体重和肌酐水平升高。
在糖尿病患者中，蛋白尿似乎是单纯冠状动脉搭桥术后死亡的一个重要预测因素。
