摘要
目的 观察慢性心力衰竭（HF）患者的肾功能及相关临床特征.方法 回顾性分析2009年9月至2011年9月在南京市胸科医院心内科住院的139例心衰患者,男性70例,女性69例,年龄（66± 15）岁,根据NYHA心功能分级,Ⅰ级40例、Ⅱ级37例、Ⅲ级34例、Ⅳ级28例.入院后次日清晨空腹抽取静脉血,全自动生化分析仪测定血浆肌酐（Cr）、尿素氮（BUN）、尿酸（UA）;根据简化的MDRD公式计算估计的肾小球滤过率（eGFR）.心脏彩超Teich法测定患者左室射血分数（LVEF）.结果 心功能＞Ⅱ级各组与Ⅰ级患者比较,患者年龄显著增高.随着心功能分级增高,LVEF逐渐降低;随着心功能分级的增高,患者BUN、Cr及UA水平逐渐增高;心功能Ⅳ级与其他各组比较eGFR水平显著降低.139例HF患者中心肾综合征（CRS）患者为96例（69％）,其中轻度、中重度肾功能不全分别为49例和47例.在肾功能正常及轻度肾功能不全组,心功能Ⅰ级患者比例高;在合并中重度肾功能不全组,心功能Ⅳ级患者比例较高.中重度肾功能不全组2年内累计心血管死亡率高于肾功能正常和轻度肾功能不全组.结论 HF患者随着心功能分级增高,年龄越大,肾功能越差;伴有中重度肾功能不全的CRS患者中心功能≥Ⅲ级比例显著增高,且预后较差.对于NYHA分级≥Ⅲ级的心衰患者,不仅需要积极强化药物治疗改善心功能,更要注意保护患者的肾功能.
Objective To observe the renal function and its effect on clinical prognosis in patients with heart failure（HF）.Methods Total 139 patients admitted in our hospital from September 2009 to September 2011 were divided into New York Heart Association （NYHA） class Ⅰ group （40 cases）,class Ⅱ group （37 cases）,class Ⅲ group（34 cases） and class Ⅳ group（28 cases）.The serum levels of blood urea nitrogen（BUN）,creatinine（Cr）,uric acid （UA）,as well as estimated glomerular filtration rate（eGFR） according to modified MDRD equation were measured.The left ventricular ejection fraction （LVEF） was determined by Doppler spectrum analysis.Results The mean age of patients above class Ⅱ] is significantly higher than that of patients in class Ⅰ.The average LVEF significantly decreased in patients with a higher class of NYHA.The levels of BUN,Cr and UA significantly increased in patients with a higher class than that in patients with class Ⅰ.Contrarily,the average eGFR remarkably decreased in patients of class Ⅳ than that in patients with a lower class.Total 96 patients of cardiorenal syndrome （CRS） were divided into mild renal insufficiency（RI） group and moderate-severe RI group.The percent of patients of class Ⅳ in moderate-severe RI group is significantly higher than that in mild RI group,while the percent of patients of class Ⅰ in moderate-severe RI group is remarkably lower.Compared the clinical prognosis,the mortality in moderate-severe RI group is highest in two year follow-up.Conclusion Patients complicated with CRS has a high incidence in heart failure.Those patients with worsening renal function have a poor outcome.It is important to protect renal function when to treat patients with heart failure above class Ⅱ of NYHA.
出处
《中国心血管病研究》
CAS
2017年第8期706-709,共4页
Chinese Journal of Cardiovascular Research
基金
国家自然科学基金项目（项目编号：81570365）：南京市医学科技发展项目（项目编号：YKK10086）
关键词
慢性心力衰竭
肾功能不全
心肾综合征
临床预后
Chronic heart failure
Renal insufficiency
Cardiorenal syndrome
Clinical prognosis
