经皮冠状动脉介入治疗的糖尿病和非糖尿病患者中降压药物对肾功能影响的差异：一项回顾性单中心队列研究。
Different effects of medications for hypertension on renal function between patients with and without diabetes mellitus undergoing percutaneous coronary intervention: a retrospective single-center cohort study.
机构信息
Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima, 890-8520, Japan.
出版信息
BMC Cardiovasc Disord. 2023 Oct 14;23(1):509. doi: 10.1186/s12872-023-03547-7.
BACKGROUND
Diabetes mellitus (DM) and hypertension are well-known atherosclerosis risk factors. Furthermore, renal dysfunction is a crucial risk factor for patients with coronary artery disease (CAD), and managing renal function in these patients is complicated because of comorbid conditions and potential side effects during treatment. Therefore, this study aimed to investigate the effect of medications for hypertension on renal function after percutaneous coronary intervention (PCI) between patients with and without DM with statins.
METHODS
In 297 consecutive patients undergoing PCI for stable angina pectoris, cystatin C (CysC) was evaluated at baseline and 9 months after PCI, and the percent change in CysC (%CysC) was calculated. The association of worsening renal function (WRF: %CysC ≥ 0) and baseline characteristics, including medications, was assessed.
RESULTS
Among 297 hypertensive patients with statins, 196 and 101 were with and without DM, respectively. Angiotensin-converting enzyme inhibitor (ACEI), angiotensin II receptor blocker, and β-blocker were prescribed in 56 (29%), 82 (42%), and 91 (46%) patients in the DM group, and 20 (20%), 52 (51%), and 52 (51%) in the non-DM group, respectively. The patients with WRF after PCI were 100 (51%) and 59 (58%) in the DM and non-DM groups (p = 0.261). Additionally, the %CysC had no significant differences between groups [median: 0%, interquartile range (IQR): -7.9% to 8.5% vs. median: 1.1%, IQR: -6.6% to 9.6%, p = 0.521]. Multivariate logistic analysis for WRF using relevant factors from univariate analysis showed that only β-blocker [odds ratio (OR): 2.76, 95% confidence interval (CI): 1.03-7.90, p = 0.048] was independently associated with WRF in the DM group whereas ACEI (OR: 0.07, 95% CI: 0.01-0.47, p = 0.012) was negatively correlated with WRF in the non-DM group.
CONCLUSION
The β-blocker was the independent risk factor for WRF in patients with DM in the late phase after PCI for stable angina pectoris, while the use of ACEI had a renoprotective effect in patients without DM.
背景
糖尿病（DM）和高血压是众所周知的动脉粥样硬化危险因素。此外，肾功能不全是冠心病（CAD）患者的重要危险因素，由于合并症和治疗过程中的潜在副作用，这些患者的肾功能管理变得复杂。因此，本研究旨在探讨在使用他汀类药物的情况下，高血压药物对接受经皮冠状动脉介入治疗（PCI）的合并 DM 和不合并 DM 患者肾功能的影响。
方法
在 297 例因稳定型心绞痛而行 PCI 的连续患者中，在基线和 PCI 后 9 个月评估胱抑素 C（CysC），并计算 CysC 的变化百分比（%CysC）。评估肾功能恶化（WRF：%CysC≥0）与基线特征（包括药物治疗）之间的关系。
结果
在 297 例使用他汀类药物的高血压患者中，196 例和 101 例分别患有 DM 和不患有 DM。DM 组中分别有 56 例（29%）、82 例（42%）和 91 例（46%）患者接受了血管紧张素转换酶抑制剂（ACEI）、血管紧张素 II 受体阻滞剂和β受体阻滞剂，而非 DM 组中分别有 20 例（20%）、52 例（51%）和 52 例（51%）患者接受了这些药物治疗。在 DM 组和非 DM 组中，WRF 患者分别为 100 例（51%）和 59 例（58%）（p=0.261）。此外，两组之间的%CysC 无显著差异[中位数：0%，四分位距（IQR）：-7.9%至 8.5% vs. 中位数：1.1%，IQR：-6.6%至 9.6%，p=0.521]。对单变量分析中相关因素进行多变量逻辑回归分析显示，仅β受体阻滞剂[比值比（OR）：2.76，95%置信区间（CI）：1.03-7.90，p=0.048]与 DM 组的 WRF 独立相关，而 ACEI（OR：0.07，95%CI：0.01-0.47，p=0.012）与非 DM 组的 WRF 呈负相关。
结论
在因稳定型心绞痛而行 PCI 的 DM 患者晚期，β受体阻滞剂是 WRF 的独立危险因素，而 ACEI 的使用对无 DM 患者具有肾脏保护作用。
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