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肾功能不全对慢性心力衰竭患者预后影响的研究
The Impact of Renal Dysfunction on Clinical Outcomes in Patients with Chronic Heart Failure

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DOI:
作者:
李金平，王玲洁，石川，胡丹凤，张凤如
LIJinPing,WANGLingJie,SHIChuanHUDanFengZHANGFengRu
作者单位:
上海交通大学医学院附属瑞金医院心内科
Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine
关键词:
慢性收缩性心力衰竭，肾功能不全，NT-proBNP，预后
chronic systolic heart failure, renal dysfunction, NT-proBNP, clinical outcome.
摘要:
目的：慢性肾功能不全（Chronic Renal Insufficiency, CRI）是慢性心力衰竭（Chronic Heart Failure, CHF）患者临床预后的独立影响因子。本研究旨在研究CRI在CHF患者中的比例，并探索其对CHF患者死亡率和因心衰再住院率的影响。 方法：共入选718名慢性收缩性心力衰竭患者（LVEF≤45%），根据简化肾脏病膳食改善方程计算估计肾小球滤过率（eGFR），并将患者分为三组：单纯CHF组（eGFR≥60ml/min/1.73m2，n=446），CHF合并中度CRI组（eGFR30～60ml/min/1.73m2，n=216），CHF合并重度CRI组（eGFR＜30ml/min/1.73m2，n=56）。 结果：本研究中约有37.9%的患者合并CRI，而临床上以血清肌酐水平升高来判定CRI时其检出率仅29.3%。随着肾功能的恶化，贫血程度逐渐加重（P＜0.001），NT-proBNP水平显著升高（P＜0.001），且NT-proBNP水平与eGFR呈显著负相关（r=-0.405，P＜0.001）。与单纯CHF患者相比，CHF合并CRI者有更高的因心衰死亡率（相对危险度RR=2.932；95%可信区间1.907～4.507；P＜0.001）和更高的因心衰的再住院率（RR=1.624；95%可信区间1.102～2.392；P =0.014）。 结论：CHF患者中CRI的比例高于我们以往的认识，且临床检出率低，一旦发生将很难逆转，并使患者对心衰治疗的敏感性下降。eGFR是死亡和因心衰再住院的强有力的预测因子,必须引起临床医生足够的重视。
Background: Chronic renal insufficiency (CRI) is another predictor of clinical outcome in chronic heart failure (CHF). The present study was designed to establish the proportion of patients with CHF that exhibits CRI and the associated risk for mortality and hospitalization due to CHF clinical deterioration. Methods and Results： Renal function was estimated with glomerular filtration rate (eGFR) using the simplified Modification of Diet in Renal Disease (MDRD) equation, and CRI was defined as eGFR＜60ml/min per 1.73m2 body surface area. 718 patients （LVEF≤45%）was enrolled and divided into 3 groups: normal renal function group (eGFR≥60ml/min per 1.73m2 body surface area, n=446) and moderate renal dysfunction group (eGFR30～60ml/min per1.73m2 body surface area, n=216) and severe renal dysfunction group (eGFR＜30ml/min per 1.73m2 body surface area, n=56). In the present study, there was 37.9% patients with renal dysfunction, while clinical detection of CRI was 29.3% judged by the increase of serum creatinine. The level of NT-proBNP increasing (P＜0.001) as eGFR decending. At the same time, NT-proBNP was negatively related to eGFR (r=-0.405，P＜0.001). There was higher rate of coexistence with anaemia (P＜0.001) in CRI patients, which got worse and worse while eGFR descending. Comparing patients with normal renal dysfunction, patients with CRI were at higher mortality (relative risk [RR], 2.932; 95% confidence interval [CI], 1.907 vs 4.507; P＜0.001), and higher rehospitalization due to CHF deterioration (RR, 1.624; CI, 1.102 vs 2.392; P =0.014). Conclusions: The ratio of CRI in CHF is higher than we recognized before, and the clinical detection is low. Once it came up, it’s hard to recover and made patients’ sensitivity to therapy decrease. Renal function as estimated by eGFR was a powerful predictor of death and rehospitalization due to CHF deterioration, which deserves more attention of clinical doctors.

 

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