急性失代偿心力衰竭高龄老年患者发生肾功能恶化及对近期预后的影响  

Worsening renal function and its influence on short-term prognosis in elderly patients with acute decompensated heart failure

作　　者：伊双艳[1] 朱兵[1] 朱启伟[1] 杜瑞雪[1] 骆雷鸣[1] 

机构地区：[1]解放军总医院南楼心血管二科,北京100853

出　　处：《中国循证心血管医学杂志》2013年第2期182-185,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：中央保健专项资金科研课题面上项目(B2009B108)

摘　　要：目的探讨急性失代偿心力衰竭(acute decompensated heart failure,ADHF)高龄老年患者肾功能恶化(worsening renal function,WRF)发病情况及对近期预后的影响。方法连续入选64例ADHF高龄老年患者,以ADHF发病初期是否发生WRF分为WRF组(n=24)和非WRF(n=40),采集两组患者病史及尿素氮、肌酐、肾小球滤过率(eGFR)、左室射血分数(LVEF)、血浆NT-proBNP等指标和利尿剂等药物使用数据,随访两组患者6个月时全因死亡率。结果 ADHF高龄老年患者WRF的发生率为37.5%。WRF组前7天应用襻利尿剂(以呋噻米剂量表示)总量显著高于非WRF组患者(P<0.05)。随访6个月时,WRF组患者中位肌酐水平较基线时水平显著升高,差异有统计学意义(P均<0.05);而非WRF组患者肌酐水平与基线时水平比较,差异无统计学意义(P>0.05)。平均随访6个月时,WRF组死亡率为62.5%,显著高于非WRF组患者的死亡率(35.0%,P<0.05)。Kaplan-Meier生存分析显示,随访期间非WRF组患者生存率显著高于WRF组患者(P<0.01)。结论 ADHF高龄老年患者在发病初期WRF发生率高,增加利尿剂剂量可能导致WRF发生风险增加,WRF导致ADHF患者的死亡率增加。Objective To investigate the attack status of worsening renal function （ WRF ） and its influence on short-term prognosis in elderly patients with acute decompensated heart failure （ ADHF ） . Methods The elderly patients with ADHF （ n=64 ） were divided into WRF group （ n=24 ） and non-WRF group （ n=40 ） . The medical history materials, indexes of blood urea nitrogen （ BUN ） , creatinine （ Cr ） , glomerular filtration rate （ GFR ） , left ventricular ejection fraction （ LVEF ） and N-terminal pro brain natriuretic peptide （ NT- proBNP ） , and administration data of diuretic were collected. The all-cause mortality was followed up in two groups after 6 months. Results The incidence rate of WRF was 37.5% in elderly patients with ADHF. The total dosage of loop diuretic （ indicated by furosemide dose ） was significantly higher in WRF group than that in non- WRF group （ P〈0.05 ） at the first 7 days. After following up for 6 months, the level of median Cr increased significantly in WRF group compared with baseline level （ P〈O.05 ） , and was not statistically significant in non- WRF group （P〉O.05） . The mortality was 62.5% in WRF group, which was significantly higher than that in non-WRF group （ 35.0%, P〈0.05 ） . The survival analysis of Kaplan-Meier showed that the survival rate was significantly higher in non-WRF group than that in WRF group （ P〈0.01 ） during follow-up period. Conclusion The incidence rate of WRF is higher in elderly patients with ADHF at early stage. The increase of diuretic dosage may lead the risk of WRF attack and higher mortality in ADHF patients.

关 键 词：急性失代偿心衰 肾功能恶化呋噻咪全因死亡 

分 类 号：R541.6[医药卫生—心血管疾病]