心力衰竭类型与肾功能的相关性研究  

Correlation between different types of heart failure and renal function

作　　者：孔祥萦[1] 沈洁[1] 高蓉蓉[1] 梅宏斌[1] 张海锋[1] 周艳丽[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,南京210029

出　　处：《临床心血管病杂志》2014年第6期509-512,共4页Journal of Clinical Cardiology

摘　　要：目的:探讨射血分数减低心力衰竭(HFrEF)和射血分数保留的心力衰竭(HFpEF)与肾功能的关系及其机制。方法:将入选的791例受试者分为HFrEF组(LVEF≤40%,317例)和HFpEF组(LVEF>40%,474例),行基本问卷调查、实验室检查及超声心动图等检查。结果:①HFrEF组尿素氮(BUN)、血尿酸(UA)均高于HFpEF组(均P<0.05),肾小球滤过率(eGFR)低于HFpEF组(P<0.05);②HFrEF组合并肾功能异常者的比例高于HFpEF组(84.5%︰76.3%,P<0.01);③多因素Logistic回归分析表明,高UA(P<0.01)及低eGFR(P<0.05)是EF≤40%(HFrEF)的独立影响因素;④Spearman及Pearson相关分析显示,两组中NYHA分级均与SCr、BUN、UA呈正相关(P<0.05),与血红蛋白、eGFR呈负相关(P<0.05),eGFR与血红蛋白呈正相关(P<0.01),eGFR与年龄、SCr、BUN、UA呈负相关(P<0.01);⑤多元线性回归分析显示,两组随着血红蛋白的减低,eGFR下降;随着左房内径(LAD)的增加,UA升高。结论:HFrEF和HFpEF肾功能均随着心功能的变化而进行性降低,HFrEF组患者更易合并肾功能异常。Objective： To investigate the relationship and mechanism between heart failure with reduced （HFrEF） or preserved ejection fraction （HFpEF） and renal function. Method：All 791 patients were divided in two groups; HFrEF group （n=317） and HFpEF group （n= 474）. Each patient achieved a questionnaire, laboratory examination and echoeardiography. Resutlt：①Compared with HFpEF group, BUN and UA in HFrEF group were elevated, while the estimated glomerular （eGFR） was decreased （P〈0. 01）. ②The ratio of renal dysfunction in HFrEF group was higher than that in HFpEF group （84.5% vs 76.3 % ）. ③Multivariate logistic analysis showed that high UA and low eGFR were independent associated factors of EF〈40 （HFpEF）. ④Spearman and Pearson correlation analysis proved that there was a positive correlation between NYHA classes and SCr, BUN, UA（P〈 0.01）, eGFR and hemoglobin, and a negative correlation between NYHA classes and eGFR, hemoglobin（P〈 0.01）, eGFR and age, SCr, BUN, UA. ⑤Multiple linear regression analysis showed that hemoglobin was affect- ing factor to eGFR. And LAD was a contributing factor to UA in two groups. Conclusion.. The exacerbated heart failure in HFrEF and HFpEF can lead to adverse effect in renal function. Our findings reveal that there are more patients with renal dysfunction in HFrEF than HFpEF.

关 键 词：心力衰竭 肾功能 射血分数 

分 类 号：R541.6[医药卫生—心血管疾病]