| Objective: Coronary heart disease has become one of the most common cardiovascular diseases, which has become a serious danger to human health and affected the quality of life. It is because the blood vessel supply to the heart is significant atherosclerotic vascular stenosis, obstruction or spasm, that coronary insufficiency, cardiac ischemia or infarction. Atherosclerosis is a systemic disease. As the inner diameter of the coronary arteries and renal artery were similar, coronary artery stenosis and renal artery stenosis often coexist, which was the display of systemic atherosclerosis. Renal artery stenosis is an independent risk factor, can cause chronic ischemic kidney failure and even cause the death of the patients. What is needed is a realization and control of cardiovascular disease risk factors. Recent studies indicate that microalbuminuria is a risk factor for cardiovascular disease. Microalbuminuria is often caused by renal artery endothelial damage or glomerular arteriosclerosis, which is an indicator of renal vascular and renal microvascular disease, as well as an early manifestation of systemic vascular lesions. The task is to study the relationship between microalbuminuria and coronary artery disease and renal artery stenosis. So explore the clinic value of microalbuminuria to coronary heart disease and renal artery stenosis.Methods: A total of 110 patients with coronary angiography (mean age 55.7+11years, 89 males, 21 females) were selected consecutively from March to November 2006, which were carried out a total of 26 patients with renal angiography. All selected patients with conventional collection of history, including smoking, family history of cardiovascular disease, diabetes history, body mass index. After resting for 15 minutes, the right brachial artery blood pressure was measured by mercury sphygmomanometer over three times. Blood samples were obtained by venipuncture for determining blood routine, liver function, kidney function, blood sugar, blood lipids. All selected patients will be investigated urine routine, suitable routine, electrocardiogram, radiography and determined urinary albumin excretion rate. The patients were divided into three groups according to the results. Risk factors for coronary heart disease defined as: male (age>65), menopause (women), smoking, diabetes, dyslipidemia [total cholesterol (Tch)≥5.72 mmol/L, low-density lipoprotein cholesterol (LDL-C)≥3.64 mmol/L, high-density lipoprotein cholesterol (HDL-C)≤1.04 mmol/L, triglyceride (TG)≥2.26 mmol/L] blood pressure≥140/90 mm Hg. BMI≥24 kg/m2, family history of cardiovascular disease [at least one first-degree relatives of heart disease before the age of 65 is clearly positive]. The coronary arteriography was used in diagnosing CHD. The renoarteriography was used in diagnosing renal artery stenosis. Exclude:①urinary system diseases such as nephritis, nephritic syndrome, urinary tract infection;②significantly increased serum creatinine;③other heart diseases such as rheumatic heart disease, cardiomyopathy, pericarditis;④the drug has been taken recently such as ACEI, ARB which can influence urinary albumin and creatinine;⑤the blood system diseases or the tumors were clearly diagnosed;⑥various causes that can cause the chronic cardiac insufficiency.All data were presented as mean±standard deviation. Initially the homogeneity of variance between all the groups was analyzed. The Students t test was used to compare the difference between two groups. ANOVA was used to deal with repeated measured data. Logistic regression analysis was used to measure the risk factor. Linear regression analysis was used to measure the correlation between microalbuminuria and the degree of coronary artery disease. A p<0.05 was considered statistically significant. All the analyses were performed with SPSS software pack (Version 11.5).Results: (1) The age of the 3 groups (the low-value group, the mid-value group, the high-value group) was 52.09±9.78, 55.80±12.24, and 59.47±8.52, respectively. The high-value group was elder than the low-value group (P<0.05). The BMI of the 3 groups was 23.25±2.43, 23.64±2.41, and 25.32±2.34. The high-value group was associated with a higher BMI than the low-value group (P<0.05). The 24-hour urinary protein was 32.94±13.38, 79.13±13.80 and 127.00±13.93, respectively. The ratio of male to female was 26/8, 37/9 and 26/4. The incidence of coronary artery disease was 61.8%, 80.4% and 93.3%. The incidence of hypertension was 47.1%, 54.3% and 76.7%. The incidence of diabetes was 2.9%, 17.4% and 36.7%. The incidence of dyslipidemia was 52.9%, 73.9% and 83.3%. There was significantly different in the 3 groups (P<0.05). The history of smoking was 26.5%, 52.2% and 50.0%. The family history was 29.4%, 30.4% and 53.3%. There was no significantly different in the 3 groups (P>0.05). (2) The analysis between microalbuminuria and traditional risk factors for coronary heart revealed that the high-value group and the mid-value group was associated with a great increasing in risk factors compared with the low-value group (P<0.05). (3) The age of the 4 groups (the control group, the group of single vessel disease, the group of double vessel disease, the group of triple vessel disease ) was 52.30±10.38, 50.24±10.09, 60.58±11.82 and 59.65±8.98, respectively; The BMI of the 4 groups was 23.12±2.26, 22.64±2.15, 23.94±1.84 and 25.49±2.47. The ratio of male to female was 14/9, 24/5, 16/3 and 35/4. The incidence of hypertension was 56.5%, 51.7%, 63.2% and 61.5%; The family history was 17.4%, 44.8%, 31.6% and 53.9%. There was no significantly different in the 4 groups (P>0.05). The 24-hour urinary protein was 51.74±30.40, 62.07±31.89, 83.68±28.73 and 102.31±36.52, respectively. The incidence of diabete was 4.3%, 13.8%, 21.1 % and 28.2%. The incidence of dyslipidemia was 34.8%, 69.0%, 84.2% and 84.6%. The history of smoking was 17.4%, 44.8%, 47.4% and 56.4%. There was significantly different in the 4 groups (P<0.05). (4) Linear regression analysis revealed that microalbuminuria correlated positively with the degree of coronary artery disease (r=0.522, P<0.005). Logistic regression analysis revealed that microalbuminuria was not an independent risk factor of coronary artery disease (p>0.05). (5) The age of the 2 groups (the control group, the group of renal artery stenosis) was 50.53±11.86 and 57.17±8.27, respectively. There was no significantly different in the 2 groups (P>0.05). The BMI of the 2 groups was 22.59±2.09 and 25.63±3.16. The 24-hour urinary protein was 52.67±41.14 and 98.33±47.64, respectively. The ratio of male to female was 12/3 and 10/2. The incidence of hypertension was 33.3% and 50.0%. The incidence of diabete was 6.7% and 8.3%. The incidence of dyslipidemia was 53.3% and 91.7%. The history of smoking was 26.7% and 50.0%. The family history was 33.3% and 66.7%. There was no significantly different in the 2 groups (P>0.05).Conclusion: There were positive correlations between microalbuminuria and coronary heart disease, and renal artery stenosis, although microalbuminuria was not an independent risk factor of coronary artery disease. The change of 24-hour urinary protein was associated with a great increasing in risk factors. The degree of coronary artery disease and renal artery stenosis in patients was associated with a great increasing in 24-hour urinary protein. |
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