在胸痛患者中，肾小球滤过率和勃起功能障碍与冠状动脉疾病严重程度的关系。
The association of glomerular filtration rate and erectile dysfunction with severity of coronary artery disease in patients presenting with chest pain.
机构信息
Meram School of Medicine, Nephrology Department, Selcuk University, 42090 Meram, Konya, Turkey.
出版信息
Int Urol Nephrol. 2010 Sep;42(3):765-71. doi: 10.1007/s11255-009-9694-y. Epub 2009 Dec 29.
BACKGROUND
The most common cause of death in patients with chronic kidney disease is cardiovascular. Coexistence of reduced estimated glomerular filtration rate (eGFR) and erectile dysfunction (ED) may predate severe underlying coronary artery disease (CAD). The aim of this study was to evaluate the predictive value of presence and severity of ED and reduced estimated eGFR in the risk stratification of CAD in patients with chest pain.
METHODS
Two hundred and sixty-five consecutive male patients with chest pain were included. All patients underwent exercise stress test (EST), of whom those with positive EST underwent coronary angiography. eGFR was calculated and sexual health inventory for men (SHIM) form was applied to evaluate ED. The relation between SHIM scores, eGFR and the number of arteries with significant lesions was evaluated.
RESULTS
Of the 265 male patients, 105 had positive EST while the remaining 160 patients had negative EST. ED was present in 62 patients (38.8%) in the EST (-) group and in 64 patients (61%) in the EST (+) group (P = 0.000). In the EST (+) group, coronary angiography (CAG) revealed normal coronary anatomy or insignificant coronary lesions in 19 (18%), one-vessel disease in 45 (43%), two-vessel disease in 22 (21%) and three-vessel disease in 19 (18%) patients, respectively. The lowest ED prevalence (36.8%) was seen in patients who had normal coronary anatomy or insignificant coronary lesions while the highest prevalence was in those with three-vessel disease (89.5%). When eGFR were taken into account, there was a significant difference between the groups as well (107.2 ± 19.2 ml/min in the EST (-) group versus 94.1 ± 20.0 ml/min in the EST (+) group; P = 0.001).
CONCLUSION
The presence and severity of ED and reduced eGFR are associated with the severity of underlying CAD in patients presenting with chest pain, and they could be implemented in the risk stratification of these patients.
背景
慢性肾脏病患者死亡的最常见原因是心血管疾病。估算肾小球滤过率（eGFR）降低和勃起功能障碍（ED）并存可能预示着严重的潜在冠状动脉疾病（CAD）。本研究的目的是评估 ED 的存在和严重程度以及 eGFR 降低在胸痛患者 CAD 风险分层中的预测价值。
方法
纳入 265 例连续男性胸痛患者。所有患者均行运动应激试验（EST），阳性 EST 患者行冠状动脉造影。计算 eGFR，应用男性健康调查（SHIM）表评估 ED。评估 SHIM 评分、eGFR 与有意义病变动脉数量之间的关系。
结果
在 265 例男性患者中，105 例 EST 阳性，160 例 EST 阴性。EST（-）组中 62 例（38.8%）存在 ED，EST（+）组中 64 例（61%）存在 ED（P=0.000）。EST（+）组中，冠状动脉造影（CAG）显示正常冠状动脉解剖或无明显冠状动脉病变 19 例（18%），单支病变 45 例（43%），两支病变 22 例（21%），三支病变 19 例（18%）。正常冠状动脉解剖或无明显冠状动脉病变患者 ED 患病率最低（36.8%），三支病变患者 ED 患病率最高（89.5%）。考虑到 eGFR，各组之间也存在显著差异（EST（-）组 107.2±19.2ml/min，EST（+）组 94.1±20.0ml/min；P=0.001）。
结论
胸痛患者 ED 的存在和严重程度以及 eGFR 降低与潜在 CAD 的严重程度相关，可用于这些患者的风险分层。
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