肾小球滤过率轻度降低与冠心病患者的冠状动脉侧支循环不良有关。
Mildly decreased glomerular filtration rate is associated with poor coronary collateral circulation in patients with coronary artery disease.
机构信息
Department of Cardiology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey.
出版信息
Clin Cardiol. 2011 Oct;34(10):617-21. doi: 10.1002/clc.20951. Epub 2011 Sep 1.
BACKGROUND
The aim of this study was to evaluate the association between mildly decreased glomerular filtration rate (GFR) and coronary collateral circulation (CCC).
HYPOTHESIS
There would be an association between mildly decreased GFR and CCC.
METHODS
Patients who had an occlusion in at least 1 major coronary artery were included in this study. Patients with severely and moderately decreased GFR were excluded. Patient data were obtained from their files. To classify CCC, we used the Rentrop classification. Patients were classified as having poor CCC (Rentrop grades 0 to 1) or good CCC (Rentrop grades 2 to 3). We used the Modification of Diet in Renal Disease (MDRD) equation to calculate GFR. Mildly decreased GFR was defined as 60 mL/min per 1.73 m(2) ≥ eGFR ≤89 mL/min per 1.73 m(2) according to the MDRD definition. Multivariate logistic regression analysis was performed to determine independent variables.
RESULTS
The study group consisted of 299 patients. Ninety-three patients had poor CCC and 206 patients had good CCC. The frequency of mildly decreased GFR was higher in the poor CCC group than in the good CCC group (P<0.001). Also, the frequency of diabetes and dyslipidemia, and the plasma high sensitive C-reactive protein levels, were higher in the poor CCC group (P = 0.003, P = 0.018, P<0.001, respectively). Logistic regression analysis revealed that eGFR is an independent predictor of CCC (B = 1.68; odds ratio = 5.4; P<0.001; 95% confidence interval, 3.1-9.4).
CONCLUSIONS
We found that CCC was worse in patients with mildly decreased GFR compared to patients with normal GFR in patients with coronary artery disease.
背景
本研究旨在评估肾小球滤过率（GFR）轻度降低与冠状动脉侧支循环（CCC）之间的关系。
假说
GFR 轻度降低与 CCC 之间存在关联。
方法
本研究纳入至少有 1 条主要冠状动脉闭塞的患者。排除严重和中度 GFR 降低的患者。从患者的病历中获取患者数据。采用 Rentrop 分级对 CCC 进行分类。将患者分为 CCC 较差（Rentrop 分级 0-1）或 CCC 较好（Rentrop 分级 2-3）。采用改良肾脏病饮食研究（MDRD）方程计算 GFR。根据 MDRD 定义，将 GFR 轻度降低定义为 60mL/min/1.73m(2)≥eGFR≤89mL/min/1.73m(2)。采用多变量逻辑回归分析确定独立变量。
结果
研究组共纳入 299 例患者。93 例患者 CCC 较差，206 例患者 CCC 较好。与 CCC 较好的患者相比，GFR 轻度降低的患者在 CCC 较差的患者中更为常见（P<0.001）。此外，在 CCC 较差的患者中，糖尿病和血脂异常的发生率以及血浆高敏 C 反应蛋白水平更高（P=0.003、P=0.018、P<0.001）。逻辑回归分析显示，eGFR 是 CCC 的独立预测因子（B=1.68；优势比=5.4；P<0.001；95%置信区间，3.1-9.4）。
结论
我们发现与 GFR 正常的冠心病患者相比，GFR 轻度降低的患者 CCC 更差。
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