作者：张伟，辛芳冉，杨忠路，贾晓丹，王辉山

单位：

1.北部战区总医院心血管外科2.北部战区总医院血液净化科

Units：

1.Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, China 2.Department of Blood Purification, General Hospital of Northern Theater Command, Shenyang 110016, China

关键词：

冠心病; 维持性血液透析; 冠状动脉狭窄; 影响因素分析;

Keywords：

Coronary disease; Maintenance hemodialysis; Coronary artery stenosis; Root cause analysis

CLC：

R 541.4

DOI：

10.12114/j.issn.1008-5971.2023.00.050

Funds：

中央引导地方科技发展资金（2021JH6/10500326）

摘要：

目的 探讨维持性血液透析（MHD）合并冠心病（CHD）患者冠状动脉病变程度的影响因素。方法选取2017年1月至2022年8月北部战区总医院收治的MHD合并CHD患者81例。收集患者的基本资料。根据冠状动脉造影检查结果，采用Gensini积分评估冠状动脉病变程度。采用Spearman秩相关分析探讨计量资料与Gensini积分的相关性。采用多重线性回归分析探讨MHD合并CHD患者Gensini积分的影响因素。结果 MHD合并CHD患者的透析龄（rs=0.228）、超敏C反应蛋白（hs-CRP）(rs=0.264)、血清磷（rs=0.264）、纤维蛋白原（FIB）(rs=0.349)、超敏心肌肌钙蛋白T(hs-cTnT)(rs=0.275)与Gensini积分呈正相关（P<0.05）。多重线性回归分析结果显示，血清钙、FIB、hs-cTnT是MHD合并CHD患者Gensini积分的影响因素（P<0.05）。结论 血清钙、FIB、hs-cTnT是MHD合并CHD患者冠状动脉病变程度的影响因素。临床医生可动态监测上述指标水平变化，以评估患者冠状动脉病变程度，进而尽早施行必要的检查及干预措施，改善患者预后。

Abstract：

Objective To investigate the influencing factors of the extent of coronary artery disease (CHD) in maintenance hemodialysis (MHD) patients with coronary heart disease. Methods A total of 81 MHD patients with CHD admitted in the General Hospital of Northern Theater Command from January 2017 to August 2022 were selected. Basic data of patients were collected. According to the results of coronary angiography, Gensini score was used to evaluate the extent of coronary artery disease. Spearman rank correlation analysis was used to explore the correlation between measurement data and Gensini score. Multiple linear regression analysis was used to investigate the influencing factors of Gensini score in MHD patients with CHD. Results Dialysis age ( r s=0.228) , hypersensitive C-reactive protein (hs-CRP) ( rs=0.264) , serum phosphorus ( rs=0.264) , fibrinogen (FIB) ( rs=0.349) , hypersensitive cardiac troponin T (hs-cTnT) ( rs=0.275) were positively correlated with Gensini scores in MHD patients with CHD (P < 0.05) . Multiple linear regression analysis showed that serum calcium, FIB, and hs-cTnT were influencing factors of Gensini score in MHD patients with CHD. Conclusion Serum Ca, FIB, and hs-cTnT are influencing factors of the extent of coronary artery disease in MHD patients with CHD. In clinical practice, changes of their levels can be dynamically monitored to evaluate the extent of coronary artery disease of patients, and necessary examination and intervention measures can be implemented as soon as possible to improve the prognosis of patients.

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