Hypolite Iman O, Bucci Jay, Hshieh Paul, Cruess David, Agodoa Lawrence Y C, Yuan Christina M, Taylor Allen J, Abbott Kevin C
Office of Minority Health Research Coordination, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
Am J Transplant. 2002 Mar;2(3):274-81. doi: 10.1034/j.1600-6143.2002.20313.x.
Coronary heart disease is the leading cause of death in both diabetes mellitus and end-stage renal disease. Although renal transplantation is known to reduce mortality in end-stage renal disease, its effect on the incidence of acute coronary syndromes is unknown. Using data from the United States Renal Data System, we studied 11,369 patients with end-stage renal disease due to diabetes enrolled on the renal and renal-pancreas transplant waiting list from 1 July 1994 to 30 June 1997. Cox nonproportional hazards regression models were used to calculate the adjusted, time-dependent relative risk for the most recent hospitalization for acute coronary syndromes (including acute myocardial infarction, unstable angina, or other acute coronary syndromes, ICD9 Code 410.x or 411.x) for a given patient in the study period. Demographics and comorbidities were controlled by using data from the medical evidence form (HCFA 2728). After renal transplantation, patients had an incidence of acute coronary syndromes of 0.79% per patient year, compared to 1.67% per patient year prior to transplantation. In comparison to maintenance dialysis, renal transplantation was independently associated with a lower risk for acute coronary syndromes (hazard ratio 0.38, 95% confidence interval, 0.30-0.49). Patients with end-stage renal disease due to diabetes on the renal transplant waiting list were much less likely to be hospitalized for acute coronary syndromes after renal transplantation. The reasons for this decreased risk should be the subject of further study.
冠心病是糖尿病和终末期肾病患者的主要死因。尽管肾移植可降低终末期肾病患者的死亡率，但其对急性冠脉综合征发病率的影响尚不清楚。我们利用美国肾脏数据系统的数据，研究了1994年7月1日至1997年6月30日登记在肾移植和肾胰联合移植等待名单上的11369例因糖尿病导致终末期肾病的患者。采用Cox非比例风险回归模型计算研究期间特定患者因急性冠脉综合征（包括急性心肌梗死、不稳定型心绞痛或其他急性冠脉综合征，ICD9编码410.x或411.x）最近一次住院的校正时间依赖性相对风险。通过使用医疗证据表（HCFA 2728）中的数据对人口统计学和合并症进行控制。肾移植后，患者急性冠脉综合征的发病率为每年0.79%，而移植前为每年1.67%。与维持性透析相比，肾移植与较低的急性冠脉综合征风险独立相关（风险比0.38，95%置信区间0.30-0.49）。在肾移植等待名单上的因糖尿病导致终末期肾病的患者在肾移植后因急性冠脉综合征住院的可能性要小得多。这种风险降低的原因应作为进一步研究的课题。
