尼可地尔对长期血液透析的终末期肾病合并缺血性心脏病患者心肌标志物及MACE的影响
Effects of nicorandil on myocardial biomarkers and MACE in patients with end-stage renal disease complicated by ischemic heart disease on long-term hemodialysis
汪晓敏 1章晨 2包程鸿2
作者信息
- 1. 310053 杭州,浙江中医药大学研究生院;浙江大学医学院附属金华医院心内科二区
- 2. 浙江大学医学院附属金华医院心内科二区
- 折叠
摘要
目的 探讨尼可地尔对长期血液透析的终末期肾病(ESRD)合并缺血性心脏病患者心肌标志物及主要不良心血管事件(MACE)的影响.方法 选取2018年6月至2022年 6月在浙江大学医学院附属金华医院接受长期血液透析治疗的112例ESRD合并缺血性心脏病患者为研究对象,其中在常规治疗基础上加用尼可地尔治疗 49例,为观察组;仅常规治疗63例,为对照组.比较两组患者治疗前及治疗1个月后心肌肌钙蛋白I(cTnI)、氨基末端脑钠肽前体(NT-proBNP)等心肌标志物,以及1年内MACE发生率;采用logistic回归模型分析ESRD合并缺血性心脏病患者血液透析过程中发生MACE的影响因素.结果 治疗前两组患者cTnI、NT-proBNP水平比较,差异均无统计学意义(均P＞0.05);治疗1个月后,观察组cTnI水平明显降低,且cTnI、NT-proBNP水平均明显低于对照组,差异均有统计学意义(均P＜0.05).观察组MACE发生率明显低于对照组,差异有统计学意义(20.4%比 39.7%,P=0.029).使用尼可地尔(OR=0.082)、左心室射血分数(OR=0.646)、NT-proBNP(OR=1.000)是ESRD合并缺血性心脏病患者血液透析过程中发生MACE的独立影响因素(均P＜0.05).结论 尼可地尔有助于降低长期血液透析的ESRD合并缺血性心脏病患者心肌标志物水平,进而减少MACE的发生.
Abstract
Objective To explore the effects of nicorandil on myocardial biomarkers and major adverse cardiova-scular event(MACE)in patients with end-stage renal disease(ESRD)complicated by ischemic heart disease under-going long-term hemodialysis.Methods A total of 112 patients with ESRD complicated by ischemic heart disease who underwent long-term hemodialysis at Jinhua Hospital Affiliated to Zhejiang University School of Medicine from June 2018 to June 2022 were selected as the study objects.The observation group included 49 patients treated with nicorandil on the basis of conventional treatment.The control group of 63 patients received only conventional treatment.Myocardial biomarkers such as cardiac troponin I(cTnI)and N-terminal pro-brain natriuretic peptide(NT-proBNP)before and after 1 month of treatment,as well as the incidence of MACE within 1 year were compared between the two groups of patients.Logistic regression model was used to analyze the influencing factors of MACE in patients with ESRD complicated by ischemic heart disease during hemodialysis.Results Before treatment,there was no significant difference in the levels of cTnI and NT-proBNP between the two groups(both P＞0.05).After 1 month of treatment,the level of cTnI in the observation group significantly decreased,and the levels of cTnI and NT-proBNP in the observation group were significantly lower than those in the control group,with statistically significant differences(all P＜0.05).The incidence of MACE in the observation group was significantly lower than that in the control group,with a statistically significant difference(20.4% vs.39.7% ,P=0.029).The use of nicorandil(OR=0.082),left ventricular ejection fraction(OR=0.646)and NT-proBNP(OR=1.000)were inde-pendent influencing factors for the occurrence of MACE during hemodialysis in ESRD patients with ischemic heart disease(all P＜0.05).Conclusion Nicorandil can reduce the level of myocardial biomarker levels in ESRD patients with ischemic heart disease undergoing long-term hemodialysis,thereby reducing the occurrence of MACE.
关键词
尼可地尔/终末期肾病/血液透析/心肌肌钙蛋白I/氨基末端脑钠肽前体Key words
Nicorandil/End-stage renal disease/Hemodialysis/Cardiac troponin I/N-terminal pro-brain natri-uretic peptide引用本文复制引用
基金项目
浙江省医学会临床科研基金(2021ZYC-A41)
金华市科技计划项目(2021-4-016)
出版年
2024
NETL
NSTL
维普
万方数据