Toriyama T, Yokoya M, Nishida Y, Kawajiri K, Takahashi H, Kawahara H
Department of Internal Medicine, Nagoya Kyoritsu Hospital.
J Cardiol. 2000 Sep;36(3):165-71.
The incidence of coronary artery disease and cardiac death was investigated in elderly diabetic patients undergoing chronic hemodialysis therapy.
Three hundred thirty-five patients who began hemodialysis therapy since 1992 were followed up by echocardiography and treadmill exercise testing. Coronary angiography was also performed in patients with angina pectoris. Angina pectoris was defined as clinical symptoms > Canadian Cardiovascular Society classification II, and asynergy findings by echocardiography or ST depression > 0.1 mV during the treadmill exercise test. Coronary artery stenosis was defined as narrowing > or = 75%. Patients were divided into 4 groups: diabetic nephropathy (DN) > or = 65 years old (Group O/DN, n = 56), DN < 65 years old (Group Y/DN, n = 84), non-DN > or = 65 years old (Group O/non-DN, n = 76) and non-DN < 65 years old (Group Y/non-DN, n = 119).
Between 1992 and 1998, there were 137 patients with angina pectoris (40.9%), 79 with coronary artery stenosis (23.6%) and 37 with cardiac death (11.0%). Cumulative incidences of angina pectoris, coronary artery stenosis and cardiac death were significantly higher in the following order of groups; O/DN > Y/DN > O/non-DN > Y/non-DN. Five-year cumulative incidences of angina pectoris, coronary artery stenosis and cardiac death in Groups O/DN vs Y/non-DN were 72.2% vs 38.6%, 53.7% vs 12.2% and 50.6% vs 3.5%, respectively. Relative risks of aging and diabetic nephropathy for angina pectoris, coronary artery stenosis and cardiac death were 3.8, 7.9 and 22.4, respectively (p < 0.0001).
Aging and the presence of diabetes are strong risk factors for coronary artery disease and cardiac death in hemodialysis patients. Therefore, diagnosis and treatment of coronary artery disease should be achieved at the early stage of hemodialysis therapy.
调查接受慢性血液透析治疗的老年糖尿病患者冠状动脉疾病和心源性死亡的发生率。
对1992年起开始接受血液透析治疗的335例患者进行超声心动图和跑步机运动试验随访。对心绞痛患者还进行了冠状动脉造影。心绞痛定义为临床症状>加拿大心血管学会分类II级，以及超声心动图显示无协同运动或跑步机运动试验期间ST段压低>0.1mV。冠状动脉狭窄定义为狭窄≥75%。患者分为4组：糖尿病肾病（DN）≥65岁（O/DN组，n=56），DN<65岁（Y/DN组，n=84），非DN≥65岁（O/非DN组，n=76）和非DN<65岁（Y/非DN组，n=119）。
1992年至1998年间，有137例心绞痛患者（40.9%），79例冠状动脉狭窄患者（23.6%）和37例心源性死亡患者（11.0%）。心绞痛、冠状动脉狭窄和心源性死亡的累积发生率按以下组序显著升高；O/DN>Y/DN>O/非DN>Y/非DN。O/DN组与Y/非DN组心绞痛、冠状动脉狭窄和心源性死亡的5年累积发生率分别为72.2%对38.6%、53.7%对12.2%和50.6%对3.5%。年龄增长和糖尿病肾病导致心绞痛、冠状动脉狭窄和心源性死亡的相对风险分别为3.8、7.9和22.4（p<0.0001）。
年龄增长和糖尿病的存在是血液透析患者冠状动脉疾病和心源性死亡的强危险因素。因此，应在血液透析治疗的早期阶段实现冠状动脉疾病的诊断和治疗。
