心力衰竭类型与肾功能的相关性研究

孔祥萦; 沈洁; 高蓉蓉; 梅宏斌; 张海锋; 周艳丽; 徐东杰; 周芳; 李新立

doi:10.13201/j.issn.1001-1439.2014.06.014

心力衰竭类型与肾功能的相关性研究

- 南京医科大学第一附属医院心内科(南京, 210029)

详细信息

通讯作者: 李新立,E-mail:xinli3267@yeah.net

中图分类号: R541.6

收稿日期: 2013-11-22

Correlation between different types of heart failure and renal function

- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, 210029, China

More Information

Corresponding author: LI Xinli, E-mail: xinli3267@yeah.net

Received Date: 22 November 2013

摘要

摘要: 目的:探讨射血分数减低心力衰竭 (HFrEF) 和射血分数保留的心力衰竭 (HFpEF) 与肾功能的关系及其机制。方法:将入选的791例受试者分为HFrEF组 (LVEF ≤ 40%, 317例) 和HFpEF组 (LVEF＞40%, 474例), 行基本问卷调查、实验室检查及超声心动图等检查。结果:①HFrEF组尿素氮 (BUN)、血尿酸 (UA) 均高于HFpEF组 (均P＜0.05), 肾小球滤过率 (eGFR) 低于HFpEF组 (P＜0.05);②HFrEF组合并肾功能异常者的比例高于HFpEF组 (84.5%:76.3%, P＜0.01);③多因素Logistic回归分析表明, 高UA (P＜0.01) 及低eGFR (P＜0.05) 是EF ≤ 40% (HFrEF) 的独立影响因素;④Spearman及Pearson相关分析显示, 两组中NYHA分级均与SCr、BUN、UA呈正相关 (P＜0.05), 与血红蛋白、eGFR呈负相关 (P＜0.05), eGFR与血红蛋白呈正相关 (P＜0.01), eGFR与年龄、SCr、BUN、UA呈负相关 (P＜0.01);⑤多元线性回归分析显示, 两组随着血红蛋白的减低, eGFR下降;随着左房内径 (LAD) 的增加, UA升高。结论:HFrEF和HFpEF肾功能均随着心功能的变化而进行性降低, HFrEF组患者更易合并肾功能异常。
- 心力衰竭 /
- 肾功能 /
- 射血分数
Abstract: Objective: To investigate the relationship and mechanism between heart failure with reduced (HFrEF) or preserved ejection fraction (HFpEF) and renal function.Method: All 791patients were divided in two groups:HFrEF group (n=317) and HFpEF group (n=474).Each patient achieved a questionnaire, laboratory examination and echocardiography.Result: ①Compared with HFpEF group, BUN and UA in HFrEF group were elevated, while the estimated glomerular (eGFR) was decreased (P＜0.01).②The ratio of renal dysfunction in HFrEF group was higher than that in HFpEF group (84.5% vs 76.3%).③Multivariate logistic analysis showed that high UA and low eGFR were independent associated factors of EF＜40 (HFpEF).④Spearman and Pearson correlation analysis proved that there was a positive correlation between NYHA classes and SCr, BUN, UA (P＜0.01), eGFR and hemoglobin, and a negative correlation between NYHA classes and eGFR, hemoglobin (P＜0.01), eGFR and age, SCr, BUN, UA.⑤Multiple linear regression analysis showed that hemoglobin was affecting factor to eGFR.And LAD was a contributing factor to UA in two groups.Conclusion: The exacerbated heart failure in HFrEF and HFpEF can lead to adverse effect in renal function.Our findings reveal that there are more patients with renal dysfunction in HFrEF than HFpEF.
- heart failure /
- renal function /
- ejection fraction

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参考文献(15)

[1]	HEYWOOD J T, FONAROW G C, COSTANZO M R, et al.High prevalence of renal dysfunction and its impact on outcome in 118, 465 patients hospitalized with acute decompensated heart failure:a report from the ADHERE database[J].J Card Fail, 2007, 13:422-430.
[2]	FOLEY R N, MURRAY A M, LI S, et al.Chronic kidney disease and the risk for cardiovascular disease, renal replacement, and death in the United States Medicare population, 1998 to 1999[J].J Am Soc Nephrol, 2005, 16:489-495.
[3]	中华医学会心血管病学分会, 中华心血管病杂志编辑委员会.慢性心力衰竭诊疗指南[J].中华心血管病杂志, 2007, 35 (12):1076-1095.
[4]	MA Y C, ZUO L, ZHANG C L, et al.Comparison of 99mTc-DTPA renal dynamic imaging with modified MDRD equation for glomerular filtration rate estimation in Chinese patients in different stages of chronic kidney disease[J].Nephrol Dial Transplant, 2007, 22:417-423.
[5]	DHAR S, KOUL D, D'ALONZO G E, JR.Current concepts in diastolic heart failure[J].J American Osteopath Assoc, 2008, 108:203-209.
[6]	SWEITZER N K, LOPATIN M, YANCY C W, et al.Comparison of clinical features and outcomes of patients hospitalized with heart failure and normal ejection fraction (＞or=55%) versus those with mildly reduced (40%to 55%) and moderately to severely reduced (＜40%) fractions[J].Am J Cardiol, 2008, 101:1151-1156.
[7]	HSIEH M C, SU H M, WANG S Y, et al.Significant correlation between left ventricular systolic and diastolic dysfunction and decreased glomerular filtration rate[J].Renal Fail, 2011, 33:977-982.
[8]	RONCO C.Cardiorenal syndromes:definition and classification[J].Contrib Nephrol, 2010, 164:33-38.
[9]	RONCO C, HAAPIO M, HOUSE A A, et al.Cardiorenal syndrome[J].J Am Coll Cardiol, 2008, 52:1527-1539.
[10]	PHILIPP S, OLLMANN H, SCHINK T, et al.The impact of anaemia and kidney function in congestive heart failure and preserved systolic function[J].Nephrol Dial Transplant, 2005, 20:915-919.
[11]	CORESH J, ASTOR B C, GREENE T, et al.Prevalence of chronic kidney disease and decreased kidney function in the adult US population:Third National Health and Nutrition Examination Survey[J].Am J Kidney Dis, 2003, 41:1-12.
[12]	SILVERBERG D S, WEXLER D, PALAZZUOLI A, et al.The anemia of heart failure[J].Acta Haematologica, 2009, 122:109-119.
[13]	SILVERBERG D S, WEXLER D, BLUM M, et al.The correction of anemia in severe resistant heart failure with erythropoietin and intravenous iron prevents the progression of both the heart and the renal failure and markedly reduces hospitalization[J].Clin Nephrol, 2002, 58:S37-45.
[14]	KITTLESON M M, ST JOHN M E, BEAD V, et al.Increased levels of uric acid predict haemodynamic compromise in patients with heart failure independently of B-type natriuretic peptide levels[J].Heart, 2007, 93:365-367.
[15]	GAGLIARDI A C, MINAME M H, SANTOS R D.Uric acid:A marker of increased cardiovascular risk[J].Atherosclerosis, 2009, 202:11-17.