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目的分析不稳定型心绞痛(unstable angina pectoris,UAP)合并慢性肾功能不全患者血栓弹力图检测结果。方法行经皮冠状动脉介入治疗的不稳定型心绞痛患者552例,根据肾小球滤过率估计值(estimated glomerular filtration rate,eGFR)水平分为肾功能不全组264例[eGFR<90mL/(min·1.73m2)]和肾功能正常组288例[eGRF≥90mL/(min·1.73m2)]。检测并比较2组血栓弹力图各指标之间的差异。结果肾功能不全组年龄、体质量、有吸烟史、合并高血压、糖尿病比例及高敏C反应蛋白、血肌酐水平高于正常肾功能组,高密度脂蛋白胆固醇和血红蛋白水平低于肾功能正常组(P<0.05);肾功能不全组冠状动脉单支病变比例(30.3%)低于肾功能正常组(48.6%),SYNTAX积分(23.9±8.3)高于肾功能正常组(18.2±7.0)(P<0.05);肾功能不全组反应时间(R值)[(5.09±1.02)min]、血凝块动力(K值)[(1.40±0.20)min]和二磷酸腺苷抑制率[(55.21±15.16)%]低于肾功能正常组[(5.58±0.76)min、(1.64±0.42)min、(64.52±17.32)%](P<0.05);血凝块强度(MA值)[(56.42±10.23)mm]、血凝块形成的速率(α角)[(66.68±10.92)°]高于肾功能正常组[(48.08±9.75)mm、(57.46±11.43)°](P<0.05);多因素回归分析显示,在控制年龄、体质量、吸烟、高血压等影响因素后,eGRF水平是二磷酸腺苷抑制率的独立影响因素(β=0.875,P=0.000)。结论合并慢性肾功能不全的UAP患者血液呈高凝状态,经皮冠状动脉介入术后需个体化抗血小板治疗以减少心血管事件。
Objective To analyze the results of thrombi elastography in patients with unstable angina pectoris (UAP) and chronic renal insufficiency. Methods 552 patients with unstable angina pectoris undergoing percutaneous coronary intervention were divided into 264 patients with renal insufficiency (eGFR <90 mL / (min · · min) according to the estimated glomerular filtration rate (eGFR) 1.73m2)] and 288 patients with normal renal function [eGRF≥90mL / (min · 1.73m2)]. The difference between each index of two groups of thrombus elastography was detected and compared. Results The age, body weight, smoking history, hypertension, diabetes mellitus, high-sensitivity C-reactive protein and serum creatinine in renal dysfunction group were higher than those in normal renal function group, and the levels of HDL-C and Hb were lower than those in normal renal function group (P <0.05). The incidence of single coronary artery disease (30.3%) in renal insufficiency group was lower than that in normal renal function group (48.6%), SYNTAX score (23.9 ± 8.3) was higher than that in normal renal function group (18.2 ± 7.0) (5.09 ± 1.02) min, K value [(1.40 ± 0.20) min] and adenosine diphosphate inhibitory rate [(55.21, P <0.05) ± 15.16)%] was lower than that in the normal renal function group (5.58 ± 0.76 min, (1.64 ± 0.42) min, (64.52 ± 17.32)%, P <0.05) (P <0.05). The rate of formation of blood clots (α angle) [(66.68 ± 10.92) °] was significantly higher than that of the normal renal function group [(48.08 ± 9.75) mm, (57.46 ± 11.43) Multivariate regression analysis showed that eGRF level was an independent factor of inhibition of adenosine diphosphate (β = 0.875, P = 0.000) after controlling for age, weight, smoking, hypertension and other factors. Conclusions UAP patients with chronic renal insufficiency show hypercoagulable blood and individualized antiplatelet therapy to reduce cardiovascular events after percutaneous coronary intervention.