2023 年第 4 期 第 18 卷

冠心病合并慢性肾衰竭维持性血液透析患者行经皮冠状动脉介入治疗的近中期疗效

Early and mid-term outcomes on percutaneous coronary intervention in patients with coronary atherosclerotic heart disease and chronic renal failure undergoing maintenance hemodialysis

作者：薛玉国张闽张东凤陈昌喆张明多周渊宋现涛

英文作者：Xue Yuguo Zhang Min Zhang Dongfeng Chen Changzhe Zhang Mingduo Zhou Yuan Song Xiantao

单位：首都医科大学附属北京安贞医院心内冠心病中心一区北京市心肺血管疾病研究所，北京100029

英文单位：Department of Cardiology 1st Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China

关键词：冠心病（冠状动脉粥样硬化性心脏病）；慢性肾衰竭；血液透析；经皮冠状动脉介入

英文关键词：Coronaryatheroscleroticheartdisease；Chronicrenalfailure；Hemodialysis；Percutaneouscoronaryintervention

• 摘要：

• 目的 探讨冠心病（冠状动脉粥样硬化性心脏病）合并慢性肾衰竭（CRF）维持性血液透析患者行经皮冠状动脉介入治疗的近中期疗效。方法 回顾性分析2013年4月至2021年10月在首都医科大学附属北京安贞医院行经皮冠状动脉介入治疗的冠心病合并CRF维持性血液透析患者，总结此类患者冠状动脉病变特点，统计围手术期及术后随访期间肾功能变化及主要不良心血管事件（MACE）发生情况。结果 39例冠心病合并CRF维持性血液透析患者中男34例、女5例，年龄（58±11）岁。患者冠状动脉病变以三支病变比例最大（48.7%，19/39），其次为双支病变（33.3%，13/39），单支病变比例最少（17.9%，7/39）。大部分为冠状动脉慢性完全闭塞病变（61.5%，24/39）。11例（28.2%）行单纯冠状动脉球囊扩张成形术，28例（71.8%）行冠状动脉支架置入术。介入手术成功率为100%。39例患者术前、术后48 h及随访12个月时的血肌酐分别为（789±282）、（729±264）、（828±318）μmol/L，血尿素氮分别为（21±7）、（17±5）、（22±7）mmol/L，不同时间比较差异均无统计学意义（均P＞0.05)。围手术期MACE发生率为5.1%（2/39）。随访期间10例（25.6%）患者因心脏事件再次入院，复查冠状动脉造影示7例患者有不同程度的支架内再狭窄。术后12、24个月MACE发生率分别为17.9%（7/39）和30.8%（12/39）。结论 冠心病合并CRF维持性血液透析患者行经皮冠状动脉介入治疗近中期疗效满意，支架内再狭窄为患者随访期间发生冠状动脉事件的主要原因，应密切随访，远期效果尚需更多病例进一步随访证实。

• Objective To investigate the early and mid-term outcomes on percutaneous coronary intervention (PCI) in patients with coronary atherosclerotic heart disease and chronic renal failure (CRF) undergoing maintenance hemodialysis. Methods From April 2013 to October 2021, patients with coronary atherosclerotic heart disease and CRF undergoing maintenance hemodialysis were retrospectively analyzed in Beijing Anzhen Hospital, Capital Medical University. The pathological characteristics of coronary artery were summarized and the major adverse cardiac event (MACE) and changes in renal function during the perioperative period and during the postoperative follow-up were analyzed. Results Among 39 patients with coronary atherosclerotic heart disease and CRF undergoing maintenance hemodialysis, 34 cases were male and 5 cases were female, and aged (58±11)years. Three-vessel lesions accounted for the largest proportion of coronary artery lesions (48.7%, 19/39), followed by double-vessel lesions (33.3%, 13/39), and single-vessel lesions accounted for the least (17.9%, 7/39). Most of them were coronary artery chronic total occlusion lesions (61.5%, 24/39). Eleven patients (28.2%) underwent simple coronary balloon angioplasty and 28 patients (71.8%) underwent coronary stent implantation. The success rate of interventional operation was 100%. The serum creatinine of 39 patients before operation, 48 h after operation and 12 months of follow-up were (789±282), (729±264), (828±318)μmol/L respectively, and blood urea nitrogen were (21±7), (17±5), (22±7)mmol/L respectively, and there was no significant difference in different time (all P＞0.05). The incidence of perioperative MACE was 5.1%(2/39). During the follow-up period, 10 patients (25.6%) were readmitted due to cardiac events, and coronary angiography showed that 7 patients had in-stent restenosis to varying degrees. The incidence of MACE was 17.9% (7/39) and 30.8% (12/39) at 12 and 24 months after operation, respectively. Conclusions  Satisfactory early and mid-term outcomes on PCI have been achieved in patients with coronary atherosclerotic heart disease and CRF undergoing maintenance hemodialysis. In-stent restenosis is the main cause of coronary event for these patients during follow-up and close follow-up is suggested. Long-term effect needs further follow-up confirmation with more cases.