Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations, Yokohama, Japan.
Nephrology (Carlton). 2012 Sep;17(7):628-35. doi: 10.1111/j.1440-1797.2012.01628.x.
Renal dysfunction is an independent risk factor for cardiovascular events. However, little is known regarding the impacts of renal dysfunction on coronary atherosclerosis.
The effects of 8-month statin therapy on coronary atherosclerosis were evaluated in the TRUTH study using virtual histology intravascular ultrasound in 164 patients with angina pectoris. We analyzed correlations between the estimated glomerular filtration rate (eGFR) and coronary atherosclerosis before and during statin therapy.
Baseline eGFR was 64.5 mL/min per 1.73 m(2) . Serum low-density lipoprotein cholesterol level decreased significantly from 132 to 85 mg/dL (-35%, P < 0.0001) after 8 months. Weak, but significant, negative correlations were observed between eGFR and external elastic membrane volume (r = -0.228, P = 0.01) and atheroma volume (r = -0.232, P = 0.01) at baseline. The eGFR was also negatively correlated with fibro-fatty volume (r = -0.254, P = 0.005) and fibrous volume (r = -0.241, P = 0.008) at baseline. Multivariate regression analyses showed that eGFR was a significant independent predictor associated with statin pre-treatment volume in fibro-fatty (β = -0.23, P = 0.01) and fibrous (β = -0.203, P = 0.02) components. Furthermore, eGFR was positively correlated with volume change in the fibro-fatty component during statin therapy (r = 0.215, P = 0.02).
Decreased eGFR is associated with expanding remodelling and a greater atheroma volume, particularly the fibro-fatty and fibrous volume before statin therapy in patients with normal to mild renal dysfunction. Reduction of fibro-fatty volume during statin therapy gradually accelerated with decreasing renal function.
肾功能不全是心血管事件的独立危险因素。然而，关于肾功能不全对冠状动脉粥样硬化的影响知之甚少。
在 164 例心绞痛患者中，使用虚拟组织学血管内超声（IVUS），在 TRUTH 研究中评估了 8 个月他汀类药物治疗对冠状动脉粥样硬化的影响。我们分析了他汀类药物治疗前后估计肾小球滤过率（eGFR）与冠状动脉粥样硬化之间的相关性。
基线时 eGFR 为 64.5 mL/min/1.73 m2。血清低密度脂蛋白胆固醇水平从 132 降至 85 mg/dL（-35%，P < 0.0001）。基线时，eGFR 与外膜体积（r = -0.228，P = 0.01）和粥样斑块体积（r = -0.232，P = 0.01）呈弱但有统计学意义的负相关。eGFR 还与纤维脂肪体积（r = -0.254，P = 0.005）和纤维体积（r = -0.241，P = 0.008）呈负相关。多元回归分析显示，eGFR 是他汀类药物治疗前纤维脂肪（β = -0.23，P = 0.01）和纤维（β = -0.203，P = 0.02）体积的独立预测因素。此外，eGFR 与他汀类药物治疗期间纤维脂肪成分的体积变化呈正相关（r = 0.215，P = 0.02）。
在肾功能正常至轻度不全的患者中，治疗前 eGFR 降低与扩张性重构和更大的粥样斑块体积相关，尤其是纤维脂肪和纤维体积。他汀类药物治疗期间纤维脂肪体积的减少随着肾功能的降低而逐渐加速。
