利用慢性肾脏病流行病学合作研究公式(CKD-EPI)对住院心力衰竭合并肾功能不全患者的应用分析  

Application of CKD-EPI Equation for Estimating the In-Hospital Patients of Chronic Heart Failure With Concomitant Renal Insufficiency

作　　者：沈洁[1] 张琪[1] 孔祥萦[1] 张海锋[1] 周艳丽[1] 樊宽鲁[1] 梅宏斌[1] 徐东杰[1] 周芳[1] 李新立[1] 

机构地区：[1]南京医科大学第一附属医院心内科,江苏省南京市210029

出　　处：《中国循环杂志》2013年第4期293-296,共4页Chinese Circulation Journal

基　　金：江苏省亚健康高危人群综合干预示范研究;江苏省科技支撑计划(社会发展)(项目号:BE2009613);青蓝工程

摘　　要：目的：利用2009年新发布的慢眭。肾脏病流行病学合作研究公式（chronickidneydiseaseepidemiologycoon，CKD-EPI）对住院心力衰竭（心衰冶．并肾功能不全患者进行分析。方法：收集2008—01至2011-12在我院心内科住院左心室射血分数≤45％的心衰患者共395例，根据CKD-EPI公式计算肾小球滤过率（GFR），按照肾脏病预后质量指南对慢性肾脏病的分期标准，将患者共分为四组：A组：GFR≥90mY（min·1.73m2），101例，B组：GFR60—89ml／（min·1.73rn2），177例，C组：GFR30—59ml／（min·1．73ln2），95例，D组：GFR〈30ml／（min．1．73m2），22例。记录患者的基本临床特征、血生化及超声心动图参数。结果：①29．60／o的住院心衰患者合并有肾功能不全。年龄、收缩压、血肌酐、胱抑素、尿素氮、尿酸随着肾功能的减退逐渐增高，合并冠已病、高血压史比例随着肾功能的减退亦逐渐增高，差异均有统计学意义（P均〈0．05）；而血钠、甘油三酯随着肾功能的减退逐渐降低，差异均有统计学意义（P均〈0．05）；NYHA分级在四组患者中差异有统计学意义（P〈O．001）；②多因素logistic回归显示：年龄（＋10岁）、收缩压（10mmng，1mmHg-133kPa）、胱抑素（mlmelL）、尿素氮（1mmol／L）等为心衰合并肾功能不全的危险因素。结论：租心衰住院患者当中，高龄、收缩压升高、高胱抑素及高尿素氮是发生肾功能不全的生物标志物。Objective： To estimate the in-hospital patients of chronic heart failure with concomitant renal insufficiency by 2009 newly issued chronic kidney disease epidemiology collaboration equation （CKD-EPI）. Methods： Our study enrolled 395 eligible patients who suffered from chronic heart failure with left ventricular ejection fraction 45% and treated in our hospital from 2008 to 2011. According to CKD-EPI equation calculated glomerular filtration rate （GFR）, the patients were divided into 4 groups. Group A, GFR I〉 90ml/（min. 1.73m2）, n=101, Group B, GFR 60-89ml/ （min 1.73m2）, n=177, Group C, GFR 30-59 ml/（min. 1.73m2）, n=95 and Group D, GFR〈30 ml/（min. 1.73m2）, n=22. The basic clinical condition, blood biochemical features and echocardiographic indexes were examined in all patients. Results： There were 29.6% in-hospital patients had concomitant renal insufficiency. As renal function decreasing, the age, systolic blood pressure, serum creatinine, cystatin, urea nitrogen and uric acid increased accordingly; at the same time, the ratios for the patients combining with coronary heart disease and hypertension were also increased, P〈0.05 respectiveey. While the levels of blood sodium and triglyceride were decreased accordingly with the decreased renal function, P〈0.05 respectively. NYHA classification was different among 4 groups, P〈0.001. Multivariate regression logistic analysis indicated that age, systolic blood pressure, cystatin and creatinine were the risk factors for heart failure patients combining with renal insufficiency. Conclusion： For in-hospital patients of chronic heart failure, the elder age, higher systolic blood pressure with increased cystatin and urea nitrogen were more risky for combining renal insufficiency.

关 键 词：CKD-EPI方程 心力衰竭 肾功能不全 危险因素 

分 类 号：R54[医药卫生—心血管疾病]