Parikh Chirag R, Coca Steven G, Smith Grace L, Vaccarino Viola, Krumholz Harlan M
Clinical Epidemiology Research Center, Veterans Affairs Medical Center, West Haven, CT 06516, USA.
Arch Intern Med. 2006 Oct 9;166(18):2014-9. doi: 10.1001/archinte.166.18.2014.
Little is known about the impact of chronic kidney disease (CKD) on health-related quality-of-life outcomes after coronary artery bypass grafting (CABG).
Our objective was to examine the changes in physical function (PF) and mental health (MH) 6 months after CABG in 1055 patients with and without CKD. The primary end points were mean change in score and status of "improved" or "worsened" in both PF and MH subscales of the Medical Outcomes Trust Short Form 36-Item Health Survey from baseline to 6 months after CABG, stratified by CKD stage (0-5).
Absolute PF and MH scores at baseline and at 6 months varied by renal impairment level. Patients with severe CKD (stages 4-5) had a mean (SD) decrease in PF score at 6 months of 3 (3) compared with increases in the rest of the cohort (P<.001). After adjustment for baseline score, 21% of patients with advanced CKD experienced worsened PF scores, compared with 0% of patients with stages 0 to 2 and stage 3 CKD (P<.001). In contrast to PF scores, patients with and without CKD had similar improvements in mean MH scores at 6 months, and patients with stages 4 to 5 CKD had the highest frequency of those with improved MH scores (77%). After adjustment, no patients experienced worsened MH scores.
After 6 months, patients with severe CKD who underwent CABG had improvement in MH but not improvement in PF and may have had worsened PF compared with those without severe CKD. Comparable evidence regarding quality-of-life outcomes in the absence of CABG is needed to more fully inform decision making regarding patients with severe CKD and coronary artery disease.
关于慢性肾脏病（CKD）对冠状动脉旁路移植术（CABG）后健康相关生活质量结局的影响，人们了解甚少。
我们的目的是研究1055例有或无CKD的患者在CABG术后6个月时身体功能（PF）和心理健康（MH）的变化。主要终点是从基线到CABG术后6个月，在医学结局信托简短健康调查36项量表的PF和MH分量表中，得分的平均变化以及“改善”或“恶化”的状态，并按CKD分期（0 - 5期）进行分层。
基线和6个月时的绝对PF和MH得分因肾功能损害程度而异。重度CKD（4 - 5期）患者在6个月时PF得分平均（标准差）下降3（3），而队列中的其他患者得分升高（P <.001）。在对基线得分进行调整后，21%的晚期CKD患者PF得分恶化，而0至2期和3期CKD患者中这一比例为0%（P <.001）。与PF得分不同，有和无CKD的患者在6个月时平均MH得分有相似的改善，4至5期CKD患者中MH得分改善的频率最高（77%）。调整后，没有患者MH得分恶化。
6个月后，接受CABG的重度CKD患者MH有所改善，但PF未改善，与无重度CKD的患者相比，其PF可能更差。需要关于未进行CABG时生活质量结局的可比证据，以便更全面地为重度CKD和冠状动脉疾病患者的决策提供信息。
