慢性肾脏病合并冠心病患者的治疗与获益学习

2019年12月第26卷增刊
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慢性肾脏病合并冠心病患者的治疗与获益学习
廖银珍1,刘璠娜1,李强2,邓丽娥2#,林捷2,匡彬2,伍冠敏1,黄思博1,查爱云1,胡波1,苏晓燕3*,尹良红1* (1暨南大学附属第一医院肾脏内科,广东广州510630;2东莞市中医院,广东东莞523005;
3中山大学附属东华医院,广东东莞523110)
慢性肾脏病患者心血管疾病发病率高,这也是导致患者死亡的主要原因[1]。

慢性肾脏病患者死于心血管疾病的可能性是发展为终末期肾病的20倍以上[2],而患急性心肌梗死的可能性是同龄人、同性别的3倍以上。

尽管CKD患者的CAD处理要比普通人群更具挑战性,但由于担心肾脏功能进一步恶化以及与治疗相关的毒性作用,CKD和接受透析治疗的患者传统上并未纳入评估的随机试验中行药物或血运重建疗效对比,仅可从小型前瞻性研究或对照试验和注册研究的回顾性分析获得的数据学习,但资料比较有限。

据统计,至少有35%的CKD患者在肾脏科医生初诊时出现过AMI或心绞痛[3];当患者开始透析时,有70%的可能性进展为严重的冠状动脉疾病[4];在透析开始后的18~24个月内,12%的患者可能发生急性心肌梗死,超过60%的患者可能发展为心力衰竭,38%的患者可能3年内猝死,猝死原因可能是冠心病[1]。

即使在血管造影正常的冠状动脉患者中,肾功能也是心血管事件(包括死亡和AMI)的重要决定因素[5]。

所以,在慢性肾脏病患者合并冠心病时,需多方面评估患者病情、并发症、手术风险、生存率等来衡量患者治疗带来的获益与风险,从而能够更好地决策患者诊疗方案。

参考文献
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[2]Herzog CA.How to manage the renal patient with coronary heart disease:the agony and the ecstasy of opinion-based medicine[J].J Am Soc Nephrol, 2013,14(10):2556-2572.
[3]Levin A.Clinical epidemiology of cardiovascular disease inchronic kidney disease prior to dialysis[J].Semin Dial,16:101-105.
[4]Joki N,Hase H,Nakamura R,et al.Onset of coronary artery disease prior to initiation of haemodialysis in patients with end-stage renal disease[J].
Nephrol Dial Transplant,1997,12(4):718-723.
[5]Zebrack JS,Anderson JL,Beddhu S,et al.Do associations with C-reactive protein and extent of coronary artery disease account for the increased car⁃diovascular risk of renal insufficiency?[J].J Am Coll Cardiol,2013,42(1):57-63.
收稿日期:2019-09-15
基金项目:广东省创新基金(2014A010101123);广东省产学研合作院士工作站(2013B090400004)
*通讯作者:尹良红,E-mail:137********@;苏晓燕:E-mail:2298440619@。

#共同第一作者:邓丽娥。

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