老年冠心病合并慢性肾脏病发病状况及其对远期预后的影响

目的 调查老年冠心病（CHD）患者合并慢性肾脏病（CKD）的发病状况及其对远期预后的影响.方法 采用回顾性队列研究的方法.纳入795例老年冠心病患者,依照基线时是否合并CKD,分为合并CKD组（n=228）与单纯CHD组（n=567）,调查两组患者的基线指标水平及相关危险因素情况.以全因死亡作为研究终点,进行10年随访,分析合并CKD对老年冠心病患者远期预后的影响及其他相关危险因素.结果 老年冠心病患者中CKD发生率为28.7%,呈现出随年龄增加递增的趋势.老年冠心病患者发生CKD的独立危险因素包括：年龄、慢性心衰病史、血红蛋白水平、血尿酸水平.随访10年,老年冠心病患者全因死亡率为32.8%,合并CKD组患者全因死亡率,显著高于单纯CHD组患者死亡率（41.7% vs.28.9%,P＜0.05）,合并CKD死亡风险是单纯CHD死亡风险的1.725倍（95%CI：25.6%～33.0%）.10年全因死亡多因素分析显示,CKD是老年冠心病全因死亡的独立危险因素.结论 住院老年冠心病患者CKD发病率高,预后不佳.CKD是老年冠心病患者全因死亡独立的危险因素.

Incidence status of senile coronary heart disease complicating chronic kidney disease and its influence on long-term prognosis

Objective To survey the incidence status of senile coronary heart disease （ CHD ） complicating chronic kidney disease （ CKD ） and its influence on long-term prognosis. Methods The method of retrospective cohort study was used to choose 795 elder],y patients with CHD, and then they were divided into CHD complicating CKD group （ CKD group, n=228 ） and CHD group （ n=567 ） according to whether the patients had CHD complicating CKD at baseline. The baseline level and relevant risk factors were surveyed in two groups. Taking all-cause mortality as study endpoint, the influence of CHD complicating CKD on long-term prognosis and other risk factors were analyzed after following up for 10 years. Results The incidence of CKD was 28.7% in elderly patients with CHD, which showed an increase trend as age increasing. The independent risk factors of CKD included age, history of chronic heart failure, hemoglobin level and blood uric acid level. After following up for l0 years, all-cause mortality was 32.8% in elderly patients with CHD. All-cause mortality was significantly higher in CKD group than that in CHD group （ 41.7% vs. 28.9%, P〈0.05 ） . The mortality risk in CKD group was 1.725 times higher than that in CHD group （ 95%CI： 25.6%-33.0% ） . The multi-factor analysis on 10-year all-cause mortality showed that CKD was an independent risk factor of all-cause mortality in elderly patients with CHD. Conclusion The incidence of CKD is higher in hospitalized elderly patients with CHD and prognosis is poor. CKD is an independent risk factor of all-cause mortality.