Yang Shi-Wei, Zhou Yu-Jie, Zhao Ying-Xin, Liu Yu-Yang, Tian Xiao-Fang, Wang Zhi-Jian, Jia De-An, Han Hong-Ya, Hu Bin, Shen Hua, Gao Fei, Wang Lu-Ya, Lin Jie, Pan Guo-Zhong, Zhang Jian, Guo Zhen-Feng, Du Jie, Hu Da-Yi
Beijing Anzhen Hospital Affiliated to Capital Medical University; Beijing Institute of Heart, Lung and Blood Vessel Disease; the Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China.
Beijing Liangxiang Hospital Affiliated to Capital Medical University; Beijing, China.
J Geriatr Cardiol. 2017 Jun;14(6):392-400. doi: 10.11909/j.issn.1671-5411.2017.06.008.
To evaluate the associations between the serum anion gap (AG) with the severity and prognosis of coronary artery disease (CAD).
We measured serum electrolytes in 18,115 CAD patients indicated by coronary angiography. The serum AG was calculated according to the equation: AG = Na[(mmol/L) + K (mmol/L)] - [Cl (mmol/L) + HCO3 (mmol/L)].
A total of 4510 (24.9%) participants had their AG levels greater than 16 mmol/L. The serum AG was independently associated with measures of CAD severity, including more severe clinical types of CAD ( < 0.001) and worse cardiac function ( = 0.004). Patients in the 4th quartile of serum AG (≥ 15.92 mmol/L) had a 5.171-fold increased risk of 30 days all-cause death ( < 0.001). This association was robust, even after adjustment for age, sex, evaluated glomerular filtration rate [hazard ratio (HR): 4.861, 95% confidence interval (CI): 2.150-10.993, < 0.001], clinical diagnosis, severity of coronary artery stenosis, cardiac function grades, and other confounders (HR: 3.318, 95% CI: 1.76-2.27, = 0.009).
In this large population-based study, our findings reveal a high percentage of increased serum AG in CAD. Higher AG is associated with more severe clinical types of CAD and worse cardiac function. Furthermore, the increased serum AG is an independent, significant, and strong predictor of all-cause mortality. These findings support a role for the serum AG in the risk-stratification of CAD.
评估血清阴离子间隙（AG）与冠状动脉疾病（CAD）严重程度及预后之间的关联。
我们对18115例经冠状动脉造影确诊的CAD患者进行了血清电解质检测。血清AG根据公式计算：AG = 钠[（毫摩尔/升）+ 钾（毫摩尔/升）]- [氯（毫摩尔/升）+ 碳酸氢根（毫摩尔/升）]。
共有4510名（24.9%）参与者的AG水平高于16毫摩尔/升。血清AG与CAD严重程度指标独立相关，包括更严重的CAD临床类型（<0.001）和更差的心功能（=0.004）。血清AG处于第四四分位数（≥15.92毫摩尔/升）的患者30天全因死亡风险增加5.171倍（<0.001）。即使在调整年龄、性别、评估的肾小球滤过率[风险比（HR）：4.861，95%置信区间（CI）：2.150 - 10.993，<0.001]、临床诊断、冠状动脉狭窄严重程度、心功能分级及其他混杂因素后，这种关联依然显著（HR：3.318，95%CI：1.76 - 2.27，=0.009）。
在这项基于大人群的研究中，我们的发现揭示了CAD患者中血清AG升高的比例较高。较高的AG与更严重的CAD临床类型和更差的心功能相关。此外，血清AG升高是全因死亡率的独立、显著且强有力的预测指标。这些发现支持血清AG在CAD风险分层中的作用。
