Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Circ J. 2010 Apr;74(4):786-91. doi: 10.1253/circj.cj-09-0715. Epub 2010 Feb 17.
The relationship between renal dysfunction and the severity of coronary artery disease (CAD) was examined.
The severity of CAD in 572 patients was graded according to the number of stenotic coronary arteries, and the estimated glomerular filtration rate (eGFR) was monitored for 3 years. Patients were stratified into 3 eGFR groups: normal (>75 ml x min(-1) x 1.73 m(-2)), mild reduction (60-75) and chronic kidney disease (CKD: <60). There were 161 patients in the CKD group. The average number of stenotic coronary arteries was larger in the CKD group than in the other groups (normal vs mild reduction vs CKD =1.35+/-0.07 (SE) vs 1.22+/-0.08 vs 1.69+/-0.08 vessel disease (VD), P<0.001). During the 3-year follow-up, the renal function of 13.8% of the patients worsened. Those who showed more deterioration of eGFR had more severe CAD than those who did not (1.20+/-0.06 vs 1.61+/-0.06 VD, P<0.001). Multivariate analysis revealed that the severity of CAD was independently and significantly associated with the deterioration of eGFR.
Patients with CKD had more severe CAD, which may explain the high rate of cardiovascular events in these patients. Moreover, the prognosis of renal function was poor in patients with severe CAD, and CAD was found to be an independent risk factor for worsening of renal dysfunction.
研究了肾功能不全与冠状动脉疾病（CAD）严重程度之间的关系。
根据狭窄冠状动脉数量对 572 例患者的 CAD 严重程度进行分级，并监测 3 年的估算肾小球滤过率（eGFR）。患者分为 3 个 eGFR 组：正常（>75 ml x min(-1) x 1.73 m(-2)）、轻度降低（60-75）和慢性肾脏病（CKD：<60）。CKD 组有 161 例患者。CKD 组患者平均狭窄冠状动脉数量大于其他组（正常组 vs 轻度降低组 vs CKD 组=1.35+/-0.07（SE） vs 1.22+/-0.08 vs 1.69+/-0.08 血管病变（VD），P<0.001）。在 3 年的随访期间，有 13.8%的患者肾功能恶化。与肾功能未恶化的患者相比，eGFR 恶化更明显的患者 CAD 更严重（1.20+/-0.06 vs 1.61+/-0.06 VD，P<0.001）。多变量分析显示，CAD 的严重程度与 eGFR 的恶化独立且显著相关。
CKD 患者 CAD 更严重，这可能解释了这些患者心血管事件发生率高的原因。此外，严重 CAD 患者的肾功能预后较差，CAD 是肾功能恶化的独立危险因素。
