肾功能不全对心脏再同步化治疗心衰患者预后的影响  

Effect of renal insuffi ciency on clinical outcomes in heart failure patients after resynchronize therapy

作　　者：杜鑫[1] 王玉堂[1] 单兆亮[1] 郭红阳[1] 国建萍[1] 

机构地区：[1]解放军总医院,北京100853

出　　处：《解放军医学院学报》2014年第5期413-415,462,共4页Academic Journal of Chinese PLA Medical School

摘　　要：目的探讨肾功能不全对心脏再同步化治疗心衰患者预后的影响。方法回顾性分析2007-2012年于解放军总医院植入心脏再同步化治疗装置的51例心衰患者。根据肾病膳食改良试验(modification of diet in renal disease,MDRD)公式法估算的肾小球滤过率(glomerular filtration rate,GFR)将患者分为两组:显著肾功能不全组(GFR<60 ml/min)和肾功能正常或轻度受损组(GFR≥60 ml/min),观察其治疗和预后情况。结果经平均31.4个月随访,显著肾功能不全组全因死亡率(Logrank检验P=0.02)及全因死亡与因心衰住院联合终点事件风险(Log-rank检验P=0.001)均显著高于肾功能正常或轻度受损组。Cox回归分析显示GFR、左心室收缩末内径(left ventricle end systole diameter,LVEDd)和血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂(ACEI/AERB)治疗与全因死亡及因心衰住院风险升高显著相关。结论肾功能不全显著增加接受心脏再同步化治疗心衰患者的死亡率和住院率。Objective To study the effect of renal insufficiency on clinical outcomes in heart failure （HF） patients after resynchronize therapy. Methods Clinical data about 51 consecutive HF patients who undewent resynchronize therapy in our hospital from 2007 to 2012 were retrospectively analyzed. The patients were divided into renal insufficiency group with its glomerular filtration rate （GFR） 〈 60 ml/min and normal renal function or mild renal function impairment group with its GFR ≥ 60 ml/min. Their clinical outcomes after resynchronize therapy were compared. Results The patients were followed up for an average period of 31.4 months. The all-cause mortality and the number of end point events were significantly higher in renal insufficiency group than in normal renal function or mild renal function impairment group （P=0.02, P=0.001）. Cox regression analysis revealed that the GFR, LVEDD, ACEI and ARB were closely related with the all-cause mortality and hospitalization rate in HF patients. Conclusion Renal insufficiency in HF patients increases their mortality and hospitalization rate after resynchronize therapy.

关 键 词：肾功能不全 心脏再同步化治疗 心力衰竭 

分 类 号：R541.6[医药卫生—心血管疾病]