| 摘要: |
| 目的：探讨冠心病合并慢性肾脏病（CKD）4-5期患者的临床特征、冠状动脉病变特点及影响长期预后的危险因素，为优化高危人群管理提供依据。方法：采用单中心回顾性研究，纳入2021年1月至2024年4月在金华市中心医院行冠脉造影诊断为冠心病且合并CKD4-5期（eGFR<30 ml/min/1.73m²）的113例患者，根据eGFR水平分为两组（eGFR≥15~<30 ml/min/1.73m²组45例，eGFR<15 ml/min/1.73m²组68例）。分别收集其基线资料、冠脉造影特征及随访1年的主要不良心血管事件（MACE）、心衰住院及出血事件数据并进行比较，以及采用Cox回归模型分析预后相关危险因素。结果：基线特征方面：冠心病合并CKD5期组糖尿病患病率更高（66.2% vs. 40.0%），血磷（1.72±0.57 vs. 1.32±0.47 mmol/L）及甲状旁腺激素（257.43±230.67 vs. 75.66±54.32 pg/mL）水平显著升高（均P<0.05）。冠脉病变方面：冠心病合并CKD5期组SYNTAX评分更高（22.31±10.75 vs. 17.16±11.02，P=0.015），提示冠脉病变更复杂。预后分析方面：两组行PCI治疗随访期间MACE、心衰住院及出血事件发生率无显著差异（P>0.05），但SYNTAX评分≥33分患者MACE风险显著升高（69.6% vs. 13.4%，P<0.001）。Cox回归显示，血磷水平、术前肌钙蛋白水平、Gensini积分和SYNTAX评分分层是发生MACE的独立危险因素（P<0.05）。结论：冠心病合并CKD4-5期患者，随着eGFR进一步下降，糖尿病患病率更高，血磷及甲状旁腺激素水平更高，冠脉病变程度更复杂。血磷水平、术前肌钙蛋白水平、Gensini积分和SYNTAX评分分层是发生MACE的独立危险因素。 |
| 关键词: 冠心病 慢性肾脏病 冠脉造影术 |
| DOI： |
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| Analysis of Clinical Characteristics and Long-Term Prognosis in Patients with Coronary Artery Disease Complicated by Stage 4-5 Chronic Kidney Disease: A Single-Center Retrospective Study |
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Li Cao, Bao Cheng Hong, Pan Yi Bin, Huang Meng Chen
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Affiliated Jinhua Hospital, Zhejiang University School of Medicine
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| Abstract: |
| Objective: To investigate the clinical characteristics, coronary artery disease features, and risk factors affecting long-term prognosis in patients with coronary artery disease (CAD) complicated by stage 4-5 chronic kidney disease (CKD), providing evidence for optimizing the management of high-risk populations.Methods: A single-center retrospective study was conducted, enrolling 113 patients diagnosed with CAD (via coronary angiography) and comorbid CKD stages 4-5 (eGFR <30 mL/min/1.73 m²) at Jinhua Central Hospital from January 2021 to April 2024. Patients were stratified into two groups based on eGFR levels: Group 1 (eGFR ≥15 to <30 mL/min/1.73 m², n=45) and Group 2 (eGFR <15 mL/min/1.73 m², n=68). Baseline data, coronary angiography characteristics, 1-year follow-up outcomes (including major adverse cardiovascular events [MACE], heart failure hospitalization, and bleeding events) were collected and compared. Cox proportional hazards regression analysis was used to identify risk factors for prognosis.Results:Baseline characteristics: The CKD stage 5 group (Group 2) had a higher prevalence of diabetes (66.2% vs. 40.0%, P<0.05), significantly elevated serum phosphorus (1.72±0.57 vs. 1.32±0.47 mmol/L, P<0.05), and parathyroid hormone levels (257.43±230.67 vs. 75.66±54.32 pg/mL, P<0.05).Coronary artery lesions: The CKD stage 5 group exhibited higher SYNTAX scores (22.31±10.75 vs. 17.16±11.02, P=0.015), indicating more complex coronary lesions.Prognostic analysis: No significant differences were observed in MACE, heart failure hospitalization, or bleeding events between the two groups after PCI (P>0.05). However, patients with SYNTAX scores ≥33 had a significantly higher MACE risk (69.6% vs. 13.4%, P<0.001). The Cox proportional hazards regression analysis identified serum phosphorus levels, preoperative cardiac troponin levels, Gensini score, and SYNTAX score stratification as independent risk factors for MACE (all P < 0.05).Conclusion: Among patients with CAD and concomitant stage 4-5 CKD, a progressive decline in eGFR was associated with: (1) higher prevalence of diabetes mellitus; (2) elevated serum phosphate and parathyroid hormone levels; and (3) increased complexity of coronary artery lesions.Serum phosphorus levels, preoperative cardiac troponin levels, Gensini score, and SYNTAX score stratification were identified as independent risk factors for MACE. |
| Key words: Coronary Artery Disease Chronic Kidney Disease Coronary Angiography |