Influence of chronic kidney disease on coronary plaque components in coronary artery disease patients with both diabetes mellitus and hypertension.
Influence of chronic kidney disease on coronary plaque components in coronary artery disease patients with both diabetes mellitus and hypertension.
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慢性肾脏病对合并糖尿病和高血压的冠心病患者冠状动脉斑块成分的影响。
DOI：
10.1007/s00380-018-01334-5
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Shin-ichiro Miura.
中科院分区：
文献类型：
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作者：
Eiji Shigemoto;Atsushi Iwata;Makito Futami;Yuta Kato;Motoki Yamashita;Satoshi Imaizumi;Takashi Kuwano;Amane Ike;Makoto Sugihara;Keijiro Saku;Shin-ichiro Miura.
众所周知，慢性肾脏病（CKD）与冠状动脉疾病（CAD）的发病率增加有关。糖尿病（DM）和高血压（HTN）是导致CKD的两个最常见原因，两者都是CAD的传统危险因素。然而，CKD对患有DM和HTN的CAD患者的冠状动脉粥样硬化的影响仍然不确定。在这些患者中，我们使用背向散射积分血管内超声（IB IVUS）检查CKD和冠状动脉斑块之间的关系。纳入了202例使用IB IVUS进行经皮冠状动脉介入治疗的患有DM和HTN的CAD患者。将患者分为CKD组（n= 106）和非CKD组（n= 96）。对冠状动脉的非罪犯段进行灰阶和IB IVUS检查。因此，尽管斑块体积百分比没有显著差异，但CKD组的脂质体积百分比显著高于非CKD组[中位数（IQR）：56.7%（45.4-67.0%）vs. 52.0%（38.3-60.2%），p= 0.03]。在所有患者中，估计的肾小球滤过率水平与脂质体积百分比呈负相关（r=-0.15，p = 0.03），与纤维化体积百分比呈正相关（r= 0.15，p = 0.04）。多变量回归分析显示，CKD是与冠状动脉斑块中脂质体积增加（β= 0.15，p = 0.047）和纤维化体积减少（β=-0.16，p = 0.03）相关的独立预测因子。总之，在同时患有糖尿病和高血压的冠心病患者中，CKD与富含脂质的冠状动脉斑块相关。CKD可能导致这些非常高风险患者的冠状动脉斑块的脆弱性。
Chronic kidney disease (CKD) is well known to be associated with an increased incidence of coronary artery disease (CAD). Diabetes mellitus (DM) and hypertension (HTN), both of which are traditional risk factors for CAD, are the two most common causes of CKD. However, the influence of CKD on coronary atherosclerosis in CAD patients who have both DM and HTN remains uncertain. In these patients, we examined the relationship between CKD and coronary plaque using integrated backscatter intravascular ultrasound (IB IVUS). Two hundred two CAD patients with both DM and HTN who underwent percutaneous coronary intervention using IB IVUS were included. The patients were divided into two groups: CKD group (n= 106) and non-CKD group (n= 96). Gray-scale and IB IVUS examinations were conducted for the non-culprit segment of a coronary artery. As a result, although there was no significant difference in the percentage of plaque volume, the percentage of lipid volume was significantly higher in the CKD group than in the non-CKD group [median (IQR): 56.7% (45.4–67.0%) vs. 52.0% (38.3–60.2%),p= 0.03]. In all of the patients, estimated glomerular filtration rate levels were negatively correlated with the percentage of lipid volume (r= − 0.15,p= 0.03) and positively correlated with the percentage of fibrosis volume (r= 0.15,p= 0.04). A multivariate regression analysis showed that CKD was an independent predictor associated with the increased lipid volume (β= 0.15,p= 0.047) and decreased fibrosis volume (β= − 0.16,p= 0.03) in coronary plaques. In conclusion, among CAD patients who had both DM and HTN, CKD was associated with lipid-rich coronary plaques. CKD may contribute to the vulnerability of coronary plaque in these very high-risk patients.