高级检索

射血分数保留心衰患者发生肾功能不全的相关因素分析

Associated factors for renal insufficiency in patients with heart failure with preserved ejection fraction

    摘要
  • 摘要:
      背景  射血分数保留的心衰(heart failure with preserved ejection fraction，HFpEF)被认为是心血管疾病患者最严重的健康威胁之一。在罹患HFpEF的同时，更有高达36.5%的患者可合并肾功能不全(renal insufficiency，RI)，其住院率、心血管病死亡率及全因死亡率均显著增加。寻找HFpEF患者发生RI的关联因素，将有助于改善HFpEF-RI共病患者的生活质量。
      目的  分析心内科就诊患者的临床指标和超声心动图参数，以得出HFpEF合并RI患者的独立关联因素。
      方法  选取2010年1月 - 2020年12月在解放军总医院第二医学中心心内科接受治疗的心衰患者共3682例，符合HFpEF诊断标准者3064例，根据慢性肾病流行病学合作研究公式计算肾小球滤过率(glomerular filtration rate，GFR)，并按照肾病预后质量指南对慢性肾病的分级标准，将HFpEF患者分为以下四组，A组：GFR≥90 mL/(min·1.73 m2)，肾功能1级，1595例；B组：60 mL/(min·1.73 m2)≤GFR＜90 mL/(min·1.73 m2)，肾功能2级，1188例；C组，30 mL/(min·1.73 m2)≤GFR＜60 mL/(min·1.73 m2)，肾功能3级，214例；D组，GFR＜30 mL/(min·1.73 m2)，肾功能4级和5级，67例。记录患者的基本临床特征、血生化及超声心动图参数，并进行四组间比较。以GFR＜60 mL/(min·1.73 m2)为RI的标准，分析发生RI的关联因素。
      结果  3 064例HFpEF患者，男2179例，女885例，平均年龄为(61.41 ± 15.00)岁。随着肾功能的下降，A、B、C、D四组间年龄、血肌酐、胱抑素、尿酸、同型半胱氨酸、氨基末端前脑钠肽、脂蛋白A和血浆纤维蛋白原、肌钙蛋白、室间隔厚度、左心室后壁厚度的差异有统计学意义(P均＜0.01)，总体呈现上升的趋势；四组间合并高血压史、糖尿病史、高脂血症史的比例也均呈现升高的趋势(P均＜0.01)，而男性比例呈现降低的趋势(P＜0.05)。9.17%的HFpEF患者合并RI。多因素logistic回归分析发现，年龄、胱抑素、同型半胱氨酸、氨基末端前脑钠肽为HFpEF患者发生肾功能不全的独立危险因素。ROC分析发现，对HFpEF患者肾功能不全的预测而言，年龄、胱抑素、同型半胱氨酸、氨基末端前脑钠肽4指标及其联合应用时，ROC-AUC (95% CI)分别为0.716(0.490 ~ 0.940)、0.791(0.644 ~ 0.941)、0.690(0.434 ~ 0.931)、0.772(0.538 ~ 0.983)、0.839(0.697 ~ 0.989)。其中胱抑素及联合应用(联合应用Log P模型)预测效能很高。
      结论  在HFpEF患者中，年龄增高、高胱抑素、高同型半胱氨酸和高氨基末端前脑钠肽与其肾功能损害密切相关，是发生RI的关联因素。胱抑素高于1.50 mg/L可作为HFpEF患者发生肾功能不全的预警指标。

     

    Abstract:
      Background  Heart failure with preserved ejection fraction (HFpEF) is considered as one of the most serious health threats in patients with cardiovascular disease. While suffering from HFpEF, up to 36.5% of patients may be complicated with renal insufficiency (RI), and their hospitalization rate, cardiovascular mortality and all-cause mortality increase significantly. Finding the associated factors of RI in HFpEF patients will be helpful to improving the quality of life and prolonging the lifespan of patients with HFpEF-RI comorbidity.
      Objective  To analyze the clinical parameters and echocardiographic parameters of patients admitting to the department of cardiology, so as to determine the risk factors of patients with HFpEF complicated with RI.
      Methods  From January 2010 to December 2020, a total of 3 682 patients with heart failure who were treated in the Department of Cardiology of the Second Medical Center of Chinese PLA General Hospital were selected, and 3 064 cases met the diagnostic criteria of HFpEF. The glomerular filtration rate (GFR) was calculated according to the epidemiological cooperative research formula of chronic kidney disease, and the HFpEF patients were divided into the following four groups according to the grading standard of the kidney disease prognosis quality guideline: group A with GFR≥90 mL/(min·1.73 m2) and renal function in grade 1 (n=1595), group B with 60≤GFR<90 mL/(min·1.73 m2) and renal function in grade 2 (n=1188), group C with 30≤GFR<60 mL/(min·1.73 m2) and renal function in grade 3 (n=214), group D with GFR<30 mL/(min·1.73m2) and renal function grade in 4 or 5 (n=67). The basic clinical characteristics, blood biochemical and echocardiographic parameters of the patients were recorded and compared among the groups. With GFR<60 mL/(min·1.73 m2) as the standard of RI, the related factors of RI were analyzed.
      Results  There were 3 064 patients with HFpEF, including 2 179 males and 885 females, with an average age of (61.41±15.00) years. With the decline of renal function, the differences in age, serum creatinine, cystatin, uric acid, homocysteine, N-terminal pro-brain natriuretic peptide, lipoprotein A, plasma fibrinogen, troponin, ventricular septal thickness and left ventricular posterior wall thickness between groups A, B, C, and D were statistically significant (all P<0.01), showing an overall upward trend. Meanwhile, the proportion of hypertension, diabetes and hyperlipidemia among the four groups also showed an increasing trend (all P<0.01). On the contrary, the proportion of male showed a decreasing trend (P<0.05). There were 9.17% of HFpEF patients combined with RI. Multivariate logistic regression analysis found that age, cystatin, homocysteine, and N-terminal pro-brain natriuretic peptide were independent risk factors for renal insufficiency in patients with HFpEF. ROC analysis found that for the prediction of renal insufficiency in HFpEF patients, the ROC-AUC (0.95%CI) for age, cystatin, homocysteine, N-terminal probrain natriuretic peptide and their combination was 0.716 (0.490-0.940), 0.791 (0.644-0.941), 0.690 (0.434- 0.931), 0.772 (0.538-0.983), 0.839 (0.697-0.989). Among them, cystatin and combined application (joint application Log P model) had high predictive efficiency.
      Conclusion  In HFpEF patients, aging, high homocysteine, high homocysteine and high N-terminal pro-brain natriuretic peptide are closely related to RI. Cystatin higher than 1.50 mg/L can be used as an early warning indicator of RI in patients with HFpEF.

     

    • HTML全文
    • 参考文献(31)
    • 相关文章
    • 施引文献
  • 资源附件(0)

/

返回文章
返回
下载中心
    友情链接