The Correlation Between The Renal Function And The Progress Of Coronary Lesions In Patients With Coronary Heart Disease After Percutaneous Coronary Intervention

Objective:The situation for the progress of coronary lesions with coronary heart disease after percutaneous coronary intervention.Study the correlation between the progress of coronary lesions with coronary heart disease after percutaneous coronary intervention and the renal function.Analysis the predict value of the early stadge and sensitive parameter of renal function for the progress of coronary lesions with coronary heart disease after percutaneous coronary intervention.Methods:Tolal of 183 coronary heart disease?CHD?patients whose CAG show the progress of coronary lesions in the original stent and at the non-stents coronary lesions after PCI for6 months or more,who had actute conronary syndrome,from the Second Clinical Hospital of Shanxi Medical University during January 2011 to June 2017 were enrolled.Patients were divided into the non-stents coronary non-progression group?n=53?,the non-stents coronary lesions progression group?n=86?and the in-stent restenosis group?n=44?based on the results of CAGs for the in-stent coronary lesions and the non-stents coronary lesions.Then they were aslo divided into normal ranal function group[eGFR?90 ml/?min·1.73m²?,n=113],mild decreased ranal function group[90 ml/?min·1.73m²?>eGFR?75ml/?min·1.73m²?,n=41]and moderate and severe decreased ranal function group[75ml/?min·1.73m²?>eGFR?30ml/?min·1.73m²?,n=29]according to eGFR at admission.The data of patients including general information,previous history,the renal function and other laboratory examination,coronary lesion,stent count and so on were entered into the computer database.SPSS17.0 were used to data analysis,univariate analysis was used to study the difference of the relevant factors between the non-progression group,lesions progression group and in-stent restenosis group.Aslo univariate analysis was used to study the difference of the coronary lesions in the three renal function groups.Multiple disorder logistic regression analysis was used to assess the effects of various factors on the progression of coronary lesions.Results:1.General information:Total of 183 patients meet the inclusion criteria and exclusion criteria were enrolled in our study,all patients received drug-coated stent?DES?implantation and reexamine CAG after PCI for more than 6 months.The average age was 33-82?61.62±10.58?years old.According to the diagnostic criteria and related medical history,104?56.8%?cases with hypertension,53?29%?patients with diabetes,65?35.5%?patients with hyperlipidemia,and 20?10.9%?cases with stroke.2.Compare the general information and renal function in the three coronary lesions group:According to the results of twice CAG,patients were divided into the non-stents coronary non-progression group?29%,53/183?,the non-stents coronary lesions progression group?47%,86/183?and in-stent restenosis group?24%,44/183?.Age,sex,blood cell analysis,blood glucose level,blood lipid level,stent count,hypertension,diabetes,hyperlipidemia and stroke have no statistically significant difference in the three groups?p>0.05?.There was significant difference for BUN,Scr,eGFR,CysC,?₂-MG,UA,MAlb,the first score of Gensini for conronary lesions,the court of conronary lesions in the three groups?p<0.05?.3.Compare the blood lipid level in the three coronary lesions group:The total rate of LDL-C,non-HDL-C who had reached the standard were 45.9%?84/183?,51.4%?94/183?.Then it were 41.5%?22/53?,54.7%?29/53?in the non-stents coronary non-progression group,54.7%?47/86?,54.7%?47/86?in the non-stents coronary lesions progression group,34.1%?15/44?,40.9%?18/44?in the in-stent restenosis group.4.Compare the conronary lesions in the three renal function group:They were aslo divided into normal ranal function group?61.8%,113/183?,mild decreased ranal function group?22.4%,41/183?and moderate and severe decreased ranal function group?15.8%,29/183?according to eGFR at admission.The first score of Gensini for conronary lesions,the rate of non-stents coronary lesions progression,the rate of in-stent restenosis and the stent count was significant difference in the three renal function groups?p<0.05?.5.Multiple disorder logistic regression analysis:Further analysis the correlation of renal function and coronary lesions for lesions progression group and in-stent restenosis group,the result shows that UA?OR=1.031,95%CI:1.014-1.049?,the score of Gensini for connary lesions?OR=1.109,95%CI:1.057-1.163?were the risk factors of lesions progression group?p<0.05?.MAlb?OR=1.877,95%CI:1.058-3.329?,?2-MG?OR=6.249,95%CI:1.772-22.033?,UA?OR=1.058,95%CI:1.033-1.084?,the score of Gensini for connary lesions?OR=1.104,95%CI:1.048-1.163?were the risk factors of in-stent restenosis group?p<0.05?.Conclusion:1.The rate of non-stents coronary lesions progression were the highest?47%?.Then the rate of in-stent restenosis were 24%.It were important to emphasize explore and control the risk factors of coronary lesions progression for CHD after PCI.It were beneficial to decrease the blood recovery rate and improve the living quality of these patients.2.The total rate of LDL-C,non-HDL-C who had reached the standard were lower?45.9%,51.4%?.Then it were 41.5%,54.7%in the non-stents coronary non-progression group,54.7%,54.7%in the non-stents coronary lesions progression group,34.1%,40.9%in the in-stent restenosis group.It showed that strengthen the treatment of liposuction positively were significant beneficial to decrease the coronary lesions progression for CHD after PCI.3.The rate of decresed renal function in CHD patients after PCI were higher?38.3%?,then mild decreased ranal function were 22.4%,and moderate and severe decreased ranal function were 15.8%.So the more server the ranal function dcreased,the higher the first score of Gensini for the conronary lesions,the more serve the coronnary lesions.The rate of non-stents coronary lesions progression and in-stent restenosis were higher,respectively were 58.6%?17/29?,31%?9/29?.4.The dcreased of renal function were the significant factor to promote the coronary lesions progression for CHD after PCI.Then the sensitive ranal function factor,such as the level of MAlb,?2-MG,UA,were the risk factor of the coronary lesions progression for CHD after PCI.So the first score of Gensini for connary lesions were the risk factor of the coronary lesions progression for CHD after PCI.