肾功能损害对慢性心力衰竭患者心脏结构的影响  

Impact of renal dysfunction on heart structure in patients with chronic heart failure

作　　者：胡丹凤[1] 石川[1] 李金平[1] 朱天奇[1] 王玮[1] 张凤如[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院心内科,200025

出　　处：《国际心血管病杂志》2010年第5期309-311,共3页International Journal of Cardiovascular Disease

摘　　要：目的:探讨肾功能损害对慢性心力衰竭患者心脏结构等方面的影响。方法:入选692例慢性心力衰竭患者,按MDRD方程计算的估算肾小球滤过率(eGFR)分为3组,A组为肾功能重度不全组[eGFR<30ml/(min.1.73m2),n=56]、B组为肾功能中度受损组[30ml/(min.1.73m2)≤eGFR<60ml/(min.1.73m2),n=206]、C组为肾功能基本正常组[eGFR≥60ml/(min.1.73m2),n=427]。比较各组患者的心超指标、基本情况、NYHA心功能分级等。其中93例行多普勒参数检查,再比较各组之间的区别。结果:慢性心力衰竭患者中约有37.86%的患者合并肾功能不全(CRI),其中有24.1%合并CRI的患者血清肌酐处于正常水平。肾功能较差的患者左室后壁厚度(LVPWT)更厚(P<0.001);重度肾功能不全患者的左房内径(LA)及室间隔厚度(IVST)较正常者也有增加(P<0.05)。合并CRI患者发生左室舒张功能不全的比例更高(P=0.043),其E/A比值较大(P=0.031),Tei指数也较大(P=0.041)。合并CRI患者NYHA的心功能分级更高(P<0.001)。此外,与单纯慢性心力衰竭组相比,CRI组N-末端B型利钠肽原(NT-proBNP)水平更高,且NT-proBNP水平与eGFR呈显著负相关(r=-0.175,P=0.025)。结论:肾功能损害加重心肌肥厚,影响左室舒张功能及NYHA心功能分级。慢性心力衰竭患者中CRI的发病率高但临床检出率低,应用NT-proBNP作为诊断依据时应充分考虑到肾功能的影响。Objective：To investigate the impact of renal dysfunction on heart structure in patients with chronic heart failure. Methods： A cohort of 692 consecutive patients with CHF confirmed by symptoms and echocardiography were enrolled in this study. The patients were divided into three groups according to their renal functions： group A [eGFR 〈30ml/（min · 1.73m^2） ,n = 56], group B [30ml/ （min· 1.73m^2）≤eGFR〈60ml/（min · 1. 73m^2）,n = 206],and Group C [eGFR≥60ml/（min·1.73m^2） ,n = 427]. Results： In this study, there were 37.86% patients with renal dysfunction, and 24.1% of which had normal serum creatinine. Compared with patients with normal renal function, patients with renal insufficiency had higher [eft ventrieular posterior wall thickness（LVPWT） （P〈0. 001） , a higher incidence of left ventricular diastolic dysfunction （P = 0. 043）, and a higher NYHA classification （P〈0. 001）. Comparing to patients with normal renal function, patients with renal dysfunction had higher level of NT-proBNP. Additionally, NT-proBNP was negatively related to eGFR （r = -0. 175, P = 0. 025）. Conclusion： There is a significant correlation between renal damage and cardiac dysfunc- tion. Renal function can affect the patients with CHF in cardiac structure and symptoms. The clinical detection rate of CRI is low in CHF. Serum concentration of NT-proBNP is affected by renal function.

关 键 词：心力衰竭 肾功能损害 超声心动图 估算肾小球滤过率 N-末端B型利钠肽原 

分 类 号：R541.6[医药卫生—心血管疾病]