Cov Yam Tseem Ceeb Ntawm Kev Tuag Ntawm Lub Plawv Rau Cov Neeg Laus Nrog Mob Raum Mob Tom Qab Percutaneous Coronary Intervention
Jul 17, 2023
Abstract
1. Lub hom phiaj
Txhawm rau txheeb xyuas cov xwm txheej txaus ntshai rau kev tuag ntawm cov neeg laus thiab mob raum mob hnyav (CKD) cov neeg mob uas muaj kab mob plawv atherosclerotic (CAHD) tom qab percutaneous coronary intervention (PCI).
2. Cov txheej txheem
1010 CAHD-CKD cov neeg mob hnub nyoog tshaj 60 xyoo uas muaj CKD theem 3 lossis siab dua thiab tau txais PCI raug soj ntsuam tsawg kawg 3 xyoos. Cov neeg mob plawv tuag tau muab faib ua pab pawg. Tom qab kev txheeb xyuas qhov tsis sib xws ntawm txhua qhov sib txawv, cov kev hloov pauv nrog P < .2 tau raug xaiv rau kev xa rov qab txuas ntxiv.
3. Cov txiaj ntsig
Rau logistic regression ib leeg-tsav kab mob (SVD) PCI OR=0.612, 95 feem pua CI: 0.416–0.899, P=.012, nws yog qhov kev tiv thaiv. Muaj plaub yam kev pheej hmoo, ruaj khov angina pectoris (SAP) LOSSIS=4.723, 95 feem pua CI: 1.098∼20.322, P=.037, ua ke nrog qis qis qis arteriosclerosis obliterans (LEASO) OR {{ 19}}.631, 95 feem pua CI: 1.272∼5.440, P=.009, K> 4.285 mmol/L OR =1.44, 95 feem pua CI: 1.002∼2.069, P {{37} }}.049, tsis muaj statins LOSSIS =2.015, 95 feem pua CI: 1.072∼3.789, P =.030.
4. Cov lus xaus
Hauv cov neeg laus thiab cov neeg mob CAHD-CKD hnyav tom qab PCI, SVD PCI yog qhov tiv thaiv kev mob plawv. Txawm li cas los xij, SAP, CAHDCKD ua ke nrog LEASO, K> 4.285 mmol / L, thiab tsis muaj cov tshuaj statins yog ib qho kev pheej hmoo ntawm kev mob plawv rau cov neeg laus uas muaj CKD hnyav tom qab PCI.
Ntsiab lus
mob raum mob, kab mob coronary atherosclerotic plawv, muaj feem cuam tshuam, prognosis.
Nyem qhov no mus yuav Cistanche ntxiv
Taw qhia
Coronary atherosclerotic heart disease (CAHD) thiab kab mob raum ntev (CKD) yog qhov muaj feem cuam tshuam rau ib leeg.1 cov neeg mob CKD yooj yim dua nrog CAHD, 2 piv txwv li, ntau dua 50 feem pua ntawm cov neeg mob uas muaj CKD hnyav yog nyuaj nrog CAHD. Lub caij no, qhov feem pua ntawm kev pheej hmoo ntawm lub neej vim yog CAHD ntau dua li qhov hnyav dua thiab kev loj hlob ntawm CKD nws tus kheej, 2 cov neeg mob CKD cov neeg laus muaj 5-10 npaug ntau dua yuav tuag los ntawm cov kab mob plawv ntau dua li tsim cov kab mob raum kawg (ESRD. ). Ntxiv nrog rau cov kev pheej hmoo ntawm cov kab mob atherosclerosis, cov neeg mob CAHD thiab CKD kuj raug cuam tshuam rau uremia-txog yam muaj feem cuam tshuam xws li o, oxidative stress, thiab calcium thiab phosphorus metabolism tsis meej. Vim qhov mob hnyav thiab tsis yooj yim ntawm cov kab mob coronary artery, cov tshuaj kho mob ntawm cov neeg mob CAHD nrog CKD tau cuam tshuam los ntawm lub raum kev ua haujlwm mus rau qib sib txawv, uas ua rau muaj kev txwv thiab cuam tshuam rau kev kho mob, tshwj xeeb tshaj yog tom qab kev cuam tshuam ntawm coronary, thiab tag nrho cov kev mob tshwm sim tsis zoo. Tshwj xeeb tshaj yog nyob rau hauv cov neeg mob laus, lub hnub nyoog yog ib qho kev pheej hmoo rau cov neeg mob CKD thiab CAHD, thiab feem ntau ntawm cov neeg mob CKD thiab CAHD yog siab dua rau cov neeg laus. Yog li ntawd, nws yog qhov tseem ceeb hauv kev kho mob kom nkag siab txog cov yam ntxwv kho mob thiab cov xwm txheej txaus ntshai rau kev tuag ntawm cov neeg laus thiab cov neeg mob CKD hnyav nrog CAHD tom qab percutaneous coronary intervention (PCI).
Cistanche extract
Cov txheej txheem
1. Kev xaiv tus neeg mob
Qhov no yog kev soj ntsuam rov qab ntawm cov neeg mob hauv tsev kho mob hauv Beijing Anzhen Tsev Kho Mob txij lub Ib Hlis 1, 2{{10}}08, txog rau lub Kaum Ob Hlis 31, 2017. Tag nrho ntawm 1010 CAHD-CKD cov neeg mob hnub nyoog tshaj 60 xyoo uas muaj CKD theem 3 lossis siab dua thiab tau txais kev cuam tshuam rau kev cuam tshuam ntawm lub plawv (PCI) raws li txoj kev kho mob ntshav qab zib. Kev kho dej dej tau ua 12 teev ua ntej PCI txog 24 teev tom qab PCI, thiab 0.9 feem pua sodium chloride 0.5-1 ml / kg.h tau txhaj tshuaj intravenously. Txhua tus neeg mob tau ua raws li tsawg kawg 3 xyoos. Cov ntaub ntawv kho mob ntawm cov neeg mob suav nrog hauv txoj kev tshawb fawb tau suav thiab txheeb xyuas. Cov txheej txheem suav nrog yog: cov neeg mob hnub nyoog tshaj 60 xyoo muaj CKD theem 3 lossis siab dua thiab tau txais PCI. Cov txheej txheem cais tawm yog: Tsis yog Neeg Esxias, hnub nyoog qis dua 60 xyoo, CKD theem 1 lossis 2, mob raum raug mob lossis rov ua haujlwm ntawm lub raum, kab mob sib kis, qog nqaij hlav, mob plawv mob hnyav (xws li, aortic dissection thiab hypertrophic cardiomyopathy), mob hnyav. kab mob kab mob, kab mob inflammatory kab mob, kho glucocorticosteroid nyob rau hauv 2 lub hlis, ua tsis tiav PCI los yog hloov mus rau coronary artery bypass grafting (CABG). PCI tau txhais tias yog balloon dilatation thiab tshuaj-eluting stent implantation tom qab coronary angiography. Thiab "kev ua tsis tiav PCI" txhais tau tias yog tsis ua haujlwm rau stent implantation thiab balloon dilation, lossis percutaneous coronary balloon dilation nkaus xwb. Daim ntawv qhia txog kev qhia txog kev kawm yog qhia hauv daim duab 1.
2. Kev txhais ntawm CKD
Cov neeg mob uas muaj keeb kwm ntawm creatinine saum toj no ib txwm muaj tsawg kawg yog 3 lub hlis lossis nrog kev kuaj pom tseeb ntawm CKD tau suav nrog, tshwj tsis yog rau cov neeg uas muaj cov qib creatinine qis zuj zus uas rov qab mus rau qhov qub thaum mus pw hauv tsev kho mob. Qhov kwv yees glomerular filtration rate (eGFR) yog xam los ntawm Cockcroft-Gault Formula 18 [(140- hnub nyoog)* lub cev hnyav (kg)/ ntshav creatinine (mg/dL)*72] (*0 .85 hauv poj niam). Cov neeg koom nrog eGFR<60 (ml/min.1.73 m2 ) were defined as CKD stage 3 according to the classification of the National Kidney Foundation.
3. Kev rho tawm cov ntaub ntawv thiab kev soj ntsuam zoo
Cov ntaub ntawv kho mob tau sau tseg ntawm cov neeg mob cov xwm txheej, xws li hnub nyoog, poj niam txiv neej, qhov siab, thiab qhov hnyav, tsev neeg keeb kwm ntawm cov kab mob plawv, thiab cov teeb meem kev pheej hmoo lossis teeb meem ntawm atherosclerosis, xws li kub siab, ntshav qab zib, dyslipidemia, cerebral infarction, thiab keeb kwm ntawm qis extremity arteriosclerosis obliterans (LEASO) txhais tau hais tias tus neeg mob muaj cov tsos mob ntawm kev sib cuam tshuam claudication los yog so qhov mob nyob rau hauv qis qis, thiab cov hlab ntsha ntawm cov hlab ntsha hauv qis qis qis qis los yog tsis muaj mem tes. Lower extremity arterial ultrasound qhia tau hais tias cov ntshav khiav tsis muaj zog los yog ploj mus, thiab lub pob taws-brachial index (ABI) yog<0.8. History of revascularization defined as previous PCI or CABG. Acute kidney injury (AKI) defined as serum creatinine was 25% higher than baseline or the absolute value was higher than 44 umol/L within 48 hours after coronary angiography. Important laboratory examinations during hospitalization mainly included routine blood examination, liver and kidney function, blood lipid level, ion detection, coronary artery impact data, and information about interventional diagnosis and treatment, including lesion characteristics, PCI target vessels, dosage of contrast agent, and postoperative effect. An Excel database was established, collating these data. The situation and time of cardiac death were recorded with telephone follow-up as the main form, supplemented by the inquiries of outpatient and inpatient medical records in Anzhen Hospital.
3. Kev Tshawb Fawb Txog Kev Tshawb Fawb
Tag nrho cov ntaub ntawv tau raug txheeb xyuas los ntawm kev siv SPSS 26.0 rau Windows (IBM Corp.), thiab Stata 15.0 (Stata Corp.) Txhua qhov sib txawv tsis tu ncua tau sim rau qhov qub uas siv txoj kev Kolmogorov– Smirnov. Nquag faib cov sib txawv tsis tu ncua yog qhia raws li tus qauv kev sib txawv, qhov tsis sib txawv ntawm qhov sib txawv yog qhia raws li qhov nruab nrab thiab qhov sib txawv ntawm qhov sib txawv, thiab categorical variables yog qhia raws li tus lej thiab feem pua. Kev txheeb xyuas qhov tseem ceeb tau txhais raws li P < .05 nrog rau kev sim ob sab. Cov neeg mob tau muab faib ua pawg raws li seb lawv puas tuag los yog tsis tau thiab seb puas muaj qhov sib txawv ntawm ob pawg. Cov ntaub ntawv ntsuas nrog ib qho kev faib tawm ib txwm raug muab piv rau ntawm ob pawg los ntawm Tub Ntxhais Kawm T-test, cov ntaub ntawv ntsuas nrog kev sib faib skewed tau muab piv los ntawm Mann-Whitney U-test, thiab cov ntaub ntawv zoo tau muab piv los ntawm chi-square test thiab Fisher qhov tseeb xeem. Tom qab kev txheeb xyuas qhov tsis sib xws ntawm txhua qhov sib txawv, cov kev hloov pauv nrog P < .2 tau raug xaiv rau kev thauj mus los txuas ntxiv, thiab txoj kev xa mus rau LR tau siv los ua kom haum tus qauv. Ob leeg yog ob tog kev xeem thiab ntawm P Tsawg dua lossis sib npaug rau .05, qhov sib txawv tau suav tias yog qhov tseem ceeb.
Cistanche capsules
Kev sib tham
Cov neeg mob lub raum tsis ua haujlwm yog qhov ua rau muaj kab mob plawv (CVD), kev tuag siab, thiab kev ua haujlwm tsis zoo.3 CVD yog qhov ua rau mob hnyav thiab tuag rau cov neeg mob CKD.4 Txog niaj hnub no, tag nrho cov kev tshawb fawb randomized ntawm myocardial revascularization tsis suav nrog CKD. cov neeg mob; Yog li ntawd, kev kho revascularization nrog CKD yog tam sim no raws li kev soj ntsuam kev tshawb fawb.5 Cov kev tshawb fawb rov qab tam sim no tau pom tias cov neeg mob CKD tau muaj sia nyob zoo dua tom qab revascularization dua li kev kho tshuaj.6,7 Cov ntaub ntawv sau npe ntau qhia tau hais tias tus neeg mob revascularization cuam tshuam nrog kev txhim kho txoj sia nyob tsis hais. ntawm qhov kwv yees glomerular filtration rate (eGFR).8 PCI yog superior rau CABG nyob rau hauv luv luv tag nrho-ua rau tuag thiab cerebrovascular kev huam yuaj npaum li cas.2,9 Txawm li cas los xij, qee qhov kev tshawb fawb tau pom tias tus nqi restenosis tom qab PCI hauv ESRD cov neeg mob yuav luag ob zaug. uas ntawm cov neeg mob uas muaj lub raum ua haujlwm.10 Cardiovascular tshwm sim (CV) kev pheej hmoo thiab kev tuag yog inversely proportional to eGFR,8 tab sis eGFR theem pib nce qhov kev pheej hmoo tsis meej meej.10,11 Cov neeg laus muaj feem ntau yuav nyuaj. nrog CAHD thiab CKD. Yog li ntawd, nws yog ib qho tseem ceeb heev rau kev soj ntsuam cov yam ntxwv ntawm cov neeg mob laus uas muaj CKD hnyav nyob rau hauv kev kho mob PCI thiab tsim kom muaj ib tug multifactor pheej hmoo kwv yees tus qauv los txhim kho kev txheeb xyuas thiab kev tswj cov neeg mob uas tsis zoo prognosis, PCI kho cov tswv yim, thiab cov chaw kho mob. prognosis ntawm cov neeg mob no.
Tam sim no, nws ntseeg tau tias cov neeg mob nrog CKD theem 3 thiab siab dua tau txais cov tswv yim tawm tsam tsis muaj kev txo qis kawg, 12 tab sis nyob rau hauv lub ntiaj teb tiag, coob tus neeg mob CKD tseem xav tau kev kho mob revascularization, uas tau tsav los ntawm cov xwm txheej mob hnyav heev. Hauv txoj kev tshawb no, PCI tsis txo qhov kev pheej hmoo ntawm plawv tuag hauv cov neeg mob CKD nrog angina ruaj khov. Qhov kev txiav txim siab no kuj tau lees paub los ntawm cov txiaj ntsig ntawm ischemia-CKD kev sim tshuaj ntsuam xyuas.13–15 Ntawm cov neeg mob uas muaj kab mob plawv ruaj khov, mob raum tsis zoo, thiab mob hnyav lossis mob ischemia, Ischemia-CKD Clinical Trials tsis tau muab pov thawj tias thawj zaug invasive. lub tswv yim, nyob rau hauv sib piv rau ib tug conservative lub tswv yim nrog maximal kev tswj xyuas, 13 txo qhov kev pheej hmoo ntawm kev tuag, myocardial infarction los yog nonfatal myocardial infarction14 thiab relieved angina cov tsos mob.15
Ib txoj kev tshawb fawb 16 suav nrog rau 453 573 cov ntsiab lus tau pom tias LEASO muaj ntau dua rau cov neeg mob CKD thiab muaj feem cuam tshuam rau cov teeb meem sab hauv qis thiab kev tuag. CKD feem ntau cuam tshuam nrog cov kab mob vascular thoob plaws piv nrog rau cov pej xeem. Cov neeg mob uas muaj ob qho tib si muaj kev ciaj sia tsawg dua.17 Qee qhov kev tshawb fawb17,18 tau qhia tias CKD cov neeg mob uas muaj albuminuria tau txo GFR, cov mob inflammatory, thiab calcium thiab phosphate metabolism tsis zoo uas ua rau lub cev puas tsuaj. Yog li, ntau tus kws sau ntawv suav tias CKD yog qhov muaj feem cuam tshuam rau cov kab mob vascular. Tam sim no, feem coob ntawm cov koom haum qhia txog kev tshawb nrhiav LEASO hauv cov neeg mob CKD. Ib txoj kev tshawb fawb tsis ntev los no txhawb cov lus qhia no vim tias cov txiaj ntsig tau pom tias ABI qis yog qhov kwv yees ntawm lub cev tsis ua haujlwm thiab kev tuag.19 Tsis tas li ntawd, peb tsis tuaj yeem tsis quav ntsej tias LEASO yog lub cim tseem ceeb ntawm cov kab mob atherosclerosis hnyav thiab muaj feem cuam tshuam nrog kev ua haujlwm tsis zoo.20
Cistanche tubulosa
Cov neeg mob CKD yuav tsum tau them nyiaj rau kev cuam tshuam ntawm electrolyte, uas cuam tshuam rau qhov tsis zoo. Rau cov neeg mob CKD, ob qho tib si hypo- thiab hyperkalemia tuaj yeem muaj kev cuam tshuam ncaj qha rau lub cev. Qee qhov meta-analyses21 qhia tias U-shaped nkhaus sib raug rau kev sib raug zoo ntawm cov qib poov tshuaj thiab kev pheej hmoo ntawm qhov tshwm sim tsis zoo, nrog rau kev pheej hmoo qis tshaj plaws ntawm cov ntshav ntshav ntawm 4-4.5 mmol / L. Hauv peb txoj kev tshawb fawb, cov txiaj ntsig kuj lees paub qhov kev txiav txim siab no. Hyperkalemia ua rau tsis zoo rau cov neeg mob CAHD, uas tej zaum yuav yog vim arrhythmia, cuam tshuam rau kev siv ACEIs lossis ARBs, thiab lwm yam.22,23.
Hauv kev ua haujlwm hauv chaw kho mob tiag tiag, qhov feem pua ntawm cov neeg mob CKD tau txais kev kho mob rov qab los yog kev kho mob revascularization txo qis; Yog li, qhov feem pua ntawm cov neeg mob CKD tau txais cov tshuaj aspirin, clopidogrel, statins, ACEIs lossis ARBs thiab -blockers yog qhov qis dua li cov neeg mob uas lub raum ua haujlwm. Qee qhov kev tshawb fawb 24 qhia tias statins muaj cov txiaj ntsig tsis zoo hauv kev txo cov kab mob plawv hauv cov neeg mob CKD, thiab statins tsis pom zoo rau cov neeg mob lim ntshav. Txawm li cas los xij, hauv lwm cov kev tshawb fawb, 25 thaum qhov qhia tau txuas ntxiv rau txhua tus neeg mob CKD, cov kws sau ntawv tau xaus lus tias kev kho atorvastatin txo qis tus txheeb ze ntawm cov txiaj ntsig loj hauv cov neeg mob CKD. Kev kho mob atorvastatin txo qis kev pheej hmoo ntawm cov hlab plawv rau cov neeg mob CKD hauv lub ntiaj teb tiag tiag piv nrog cov kev kho mob ib txwm muaj, thiab tsis muaj qhov sib txawv tseem ceeb hauv kev kho mob ntawm cov neeg mob thiab tsis muaj CKD. Tsis tas li ntawd, eGFR tsis txo qis hauv cov neeg mob kho nrog atorvastatin thaum lub sijhawm kawm.
SVD PCI yog ib qho kev tiv thaiv tiv thaiv kab mob plawv thiab tej zaum yuav muaj feem cuam tshuam rau CAHD me me thiab tsis mob hnyav thiab nyuaj vascular kab mob. SVD PCI tuaj yeem tswj tau qhov ntau npaum li cas ntawm qhov sib piv nruab nrab thiab zam qhov ua rau lub raum ua haujlwm puas lossis AKI.
CAHD muaj ntau heev hauv CKD. CKD hloov pauv cov xwm txheej pheej hmoo rau atherosclerosis, thiab CKD muaj qee yam tshwj xeeb, xws li mob thiab hloov pauv hauv cov metabolism hauv cov ntxhia, ua lub luag haujlwm tseem ceeb hauv kev ua rau lub raum tsis ua haujlwm.26 Yog li ntawd, nws tseem ceeb heev rau kev kho mob kom nkag siab. cov kev pheej hmoo ntawm kev pheej hmoo rau cov neeg mob hnyav CKD nyuaj nrog CAD.
Standardized Cistanche
Cov lus xaus
Hauv cov neeg laus thiab cov neeg mob CAHD-CKD hnyav tom qab PCI, SVD PCI yog qhov tiv thaiv kev mob plawv. Txawm li cas los xij, SAP, CAHD-CKD ua ke nrog LEASO, K> 4.285 mmol / L, thiab tsis muaj cov tshuaj statins yog ib qho kev pheej hmoo ntawm kev mob plawv rau cov neeg laus uas muaj CKD hnyav tom qab PCI.
Cov ntaub ntawv
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Ying Zhang, MD1,2,3, Guangyao Zhai, MD1,2, Jianlong Wang, MD1,2, thiab Yujie Zhou, MD, PhD1,2
1 Department of Cardiology, 12th pawg ntseeg, Beijing Anzhen Tsev Kho Mob, Capital Medical University, Beijing, Suav
2 Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, Suav.
3 Department of Cardiology, Affiliated Hospital of Chengde Medical College, Chengde, Suav
