Eijkelkamp Wouter B A, de Graeff Pieter A, van Veldhuisen Dirk J, van Dokkum Richard P E, Gansevoort Ronald T, de Jong Paul E, de Zeeuw Dick, Hillege Hans L
Department of Clinical Pharmacology, Division of Nephrology, University Medical Center Groningen, Groningen, The Netherlands.
Am J Cardiol. 2007 Jul 1;100(1):7-12. doi: 10.1016/j.amjcard.2007.02.047. Epub 2007 May 7.
Effects of cardiovascular dysfunction on renal function have been poorly characterized. Therefore, we investigated the relation between a first ischemic cardiac event and long-term renal function changes in the general population from the PREVEND study. We studied 6,360 subjects with a total follow-up duration of 27.017 subject-years. The estimated mean proportional increase in serum creatinine after a first ischemic cardiac event was 3.1% compared with 0.4% per year of follow-up in subjects without such an event (p = 0.005). This represented a significantly larger decrease in estimated glomerular filtration rate after the event in subjects with an event versus the decrease in subjects without a first ischemic cardiac event (2.2 vs 0.5 ml/min/1.73 m(2)/year of follow-up, p = 0.006). In multivariate analysis with adjustment for renal risk factors, this event showed an independent association with serum creatinine change. In conclusion, a first ischemic cardiac event appears to enhance the natural decrease in renal function. Because even mild renal dysfunction should be considered a major cardiovascular risk factor after myocardial infarction, increased renal function loss after an ischemic cardiac event could add to the risk for subsequent cardiovascular morbidity, thus closing a vicious circle.
心血管功能障碍对肾功能的影响一直未得到充分描述。因此，我们从PREVEND研究中调查了一般人群中首次缺血性心脏事件与长期肾功能变化之间的关系。我们研究了6360名受试者，总随访时长为27.017人年。首次缺血性心脏事件后血清肌酐估计平均比例增加3.1%，而无此类事件的受试者随访期间每年增加0.4%（p = 0.005）。这表明发生事件的受试者事件后估计肾小球滤过率的下降幅度明显大于未发生首次缺血性心脏事件的受试者（随访期间分别为2.2和0.5 ml/min/1.73 m²/年，p = 0.006）。在对肾脏危险因素进行调整的多变量分析中，该事件与血清肌酐变化呈独立关联。总之，首次缺血性心脏事件似乎会加速肾功能的自然下降。由于即使是轻度肾功能障碍在心肌梗死后也应被视为主要心血管危险因素，缺血性心脏事件后肾功能丧失增加可能会增加随后心血管疾病的发病风险，从而形成恶性循环。
