慢性腎疾病病人的冠狀動脈疾病的藥物治療及冠狀動脈血管成形手術

Pharmalogical Management and Revascularization Procedures of Coronary Artery Disease in Patients with Chronic Kidney Disease

王震宇(Jenn-Yeu Wang) ； 王登鶴(Teng-Ho Wang) ； 留以堅(Yi-Chien Liu) ； 黃碧桃(Be-Tau Hwang)

《內科學誌》 22卷3期 (2011/06) Pp. 145-152

https://doi.org/10.6314/JIMT.2011.22(3).01

摘要

雖然一般大眾的心血管疾病的死亡率已下降，但是慢性腎疾病病人的心血管疾病卻沒有如此的下降。心血管疾病在慢性腎疾病的發生率甚至很高，並且造成這些病人預後不良及約佔50%死亡原因。慢性腎疾病病人的心血管疾病惡化之速度比一般大眾大約快二倍，甚至未進展至末期腎病變前就已死亡。然而大量增加之危險性是由於傳統性的危險因子的盛行率較高及尿毒症相關因子所造成的。冠狀動脈粥樣硬化和心臟衰竭與腎功能衰退的進程有獨立的相關，即所謂心腎症候群。除了矯正傳統性的危險因子和尿毒症相關因子外，處理慢性腎疾病病人之心血管疾病應該要提早轉介給專家醫療照護。慢性腎疾病病人若有左主冠狀動脈疾病或三條冠狀動脈疾病，或不穩定心絞痛，則冠狀動脈血管成形手術是需要的。在本文主要討論冠狀動脈疾病的藥物治療及冠狀動脈血管成形手術。

關鍵字

心腎症候群 ； 冠狀動脈疾病 ； 心血管疾病 ； 慢性腎疾病 ； 慢性腎衰竭 ； 冠狀動脈血管成形手術

並列摘要

In an era when mortality due to cardiovascular disease has been declining in the general population, no such reduction in mortality from cardiovascular disease has been noted for chronic kidney disease (CKD). The incidence of cardiovascular disease is very high in CKD and accounts for poor prognosis and almost half of deaths in these patients. Cardiovascular disease progresses at twice the rate in CKD and is associated with death before end stage renal disease. The greatly increased risk is due to higher prevalence of both traditional risk factors as well as uremia-related risk factors. Coronary atherosclerosis and heart failure have independent associations with kidney function decline progression, the so-called cardiorenal syndrome. Besides modification of these risk factors, early detection and management of cardiovascular disease and referral for speciality care should begin during the course of CKD. In patients with CKD who have left main coronary artery disease (CAD), or triple-vessel CAD, or unstable angina, coronary revascularization procedures are needed. Our article dicusses pharmacological management and revascularization procedures for coronary artery disease.

並列關鍵字

Cardiorenal syndrome ； Coronary artery disease ； Cardiovascular disease ； Chronic kidney disease ； Chronic renal failure ； Coronary revascularization procedures