慢性肾脏病患者中的急性冠状动脉综合征：临床与治疗特征。
Acute Coronary Syndromes in Chronic Kidney Disease: Clinical and Therapeutic Characteristics.
机构信息
Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania.
Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania.
出版信息
Medicina (Kaunas). 2020 Mar 8;56(3):118. doi: 10.3390/medicina56030118.
This study evaluated the clinical characteristics of the acute coronary syndromes (ACS) in chronic kidney disease (CKD) patients and established prognostic values of the biomarkers and echocardiography. 273 patients admitted to the cardiology department of the Clinical County Emergency Hospital of Oradea, Romania, with ACS diagnosis were studied. Two study groups were formed according to the presence of CKD (137 patients with ACS + CKD and 136 with ACS without CKD). Kidney Disease: Improving Global Outcomes (KDIGO) threshold was used to assess the stages of CKD. Data regarding the medical history, laboratory findings, biomarkers, echocardiography, and coronary angiography were analysed for both groups. ACS parameters were represented by ST-segment elevation myocardial infarction (STEMI), which revealed a greater incidence in subjects without CKD (43.88%); non-ST-segment elevation myocardial infarction (NSTEMI), characteristic for the CKD group (28.47%, with statistically significance = 0.04); unstable angina and myocardial infarction with nonobstructive coronary arteries (MINOCA). Diabetes mellitus, chronic heart failure, previous stroke, and chronic coronary syndrome were more prevalent in the ACS + CKD group (56.93%, < 0.01; 41.61%, < 0.01; 18.25%, < 0.01; 45.26%, < 0.01). N-terminal pro b-type natriuretic peptide (NT-proBNP) was statistically higher ( < 0.01) in patients with CKD; Killip class 3 was evidenced more frequently in the same group ( < 0.01). Single-vessel coronary artery disease (CAD) was statistically more frequent in the ACS without CKD group (29.41%, < 0.01) and three-vessel CAD or left main coronary artery disease (LMCA) were found more often in the ACS + CKD group (27.01%, 14.6%). Extension of the CAD in CKD subjects revealed an increased prevalence of the proximal CAD, and the involvement of various coronary arteries is characteristic in these patients. Biomarkers and echocardiographic elements can outline the evolution and outcomes of ACS in CKD patients.
本研究评估了慢性肾脏病（CKD）患者急性冠状动脉综合征（ACS）的临床特征，并建立了生物标志物和超声心动图的预后价值。 对罗马尼亚奥拉迪亚临床县急诊医院心内科收治的 273 例 ACS 患者进行了研究。根据 CKD 的存在情况将患者分为两组（ACS+CKD 患者 137 例，ACS 无 CKD 患者 136 例）。采用肾脏疾病：改善全球预后（KDIGO）标准评估 CKD 分期。 对两组患者的病史、实验室检查结果、生物标志物、超声心动图和冠状动脉造影等数据进行了分析。ACS 各参数分别为 ST 段抬高型心肌梗死（STEMI），无 CKD 患者发生率更高（43.88%）；非 ST 段抬高型心肌梗死（NSTEMI），CKD 组特征性表现（28.47%，具有统计学意义 = 0.04）；不稳定型心绞痛和非阻塞性冠状动脉心肌梗死（MINOCA）。ACS+CKD 组中糖尿病、慢性心力衰竭、既往卒中、慢性冠状动脉综合征更为常见（56.93%， < 0.01；41.61%， < 0.01；18.25%， < 0.01；45.26%， < 0.01）。CKD 患者的 N 末端脑利钠肽前体（NT-proBNP）水平明显升高（ < 0.01）；同一组中 Killip 分级 3 级更为常见（ < 0.01）。ACS 无 CKD 组单支血管病变（CAD）发生率明显更高（29.41%， < 0.01），ACS+CKD 组三支血管 CAD 或左主干冠状动脉疾病（LMCA）更为常见（27.01%，14.6%）。 CKD 患者 CAD 病变范围更广，近端 CAD 更为常见，多支冠状动脉受累更为常见。生物标志物和超声心动图指标可描绘 CKD 患者 ACS 的演变和结局。
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