他汀肾脏保护.ppt

After a median follow-up of 5.0 years, irrespective of treatment assignment, 351 patients with CKD (11.3%) experienced a first major cardiovascular event compared with 561 patients with normal eGFR at baseline (8.6%).1 Thus patients with CKD were at a significantly greater risk of major cardiovascular events than patients with normal renal function (HR = 1.35; 95% CI: 1.18, 1.54; P.0001).1 Reference 1. Shepherd J, Kastelein JJP, Bittner V et al, for the Treating to New Targets Investigators. Intensive lipid lowering with atorvastatin in patients with coronary heart disease and chronic kidney disease: the Treating to New Targets (TNT) Study. J Am Coll Cardiol. 2008;51:1448-1454. 在来自EXCITE（口服Xemilofiban珍米洛非班控制血栓性事件的评估）研究中的5835名PCI术后患者中，评估尿试纸蛋白尿与死亡率和心血管事件（死亡、MI、或非出血性卒中的复合事件）的相关性。在PCI术前进行试纸尿检，蛋白尿定义为达到或超过迹线。患者入组后随访210天/7个月至发生事件。多因素回归分析评估蛋白尿与每一终点事件的相关性。 患者平均年龄59岁，21%为女性，18%有糖尿病，平均估算肾小球滤过率（eGFR）为90ml/min/1.73 m2。750（13%）名患者存在蛋白尿。随访中，22（2.9%）名有蛋白尿的患者和54（1.1%）名无蛋白尿患者死亡（调整后风险比2.83，95%CI 1.65－4.84，P0.001）。 In conclusion, proteinuria was strongly and independently associated with mortality in patients undergoing PCI. These data suggest that such a relatively simple and clinically easy to use tool as urinary dipstick may be useful to identify and treat patients at high risk of mortality at the time of PCI. ? 2008 Elsevier Inc. All rights reserved. * * Weighted mean differences (WMD)：加权均数差值 Standardised mean difference (SMD)：标化均数差值 Meta分析中常用的统计学参数： 对于连续性变量，当各临床试验结果测量采用相同测定方法时选择加权均数差值(weighted mean difference, WMD) 及其95%CI; 而当结果测量采用不同测定方法时, 则选择标化均数差值(standardized mean difference, SMD) 及其95%CI。 对于分类变量，常用比值比(odds ratio)、相对危险度(relative risk)等作为效应指标表示合成结果。 Twenty-seven eligible studies with 39,704 participants (21 with data for eGFR and 20 for proteinuria or albuminuria) were identified. Overall, the change in the weighted mean differences for eGFR was statistically significant (1.22 ml/min per yr slower in statin recipients; 95% confidence interval [CI] 0.44 to 2.00). In subgroup