心力衰竭患者蛋白尿和住院期间不良事件的关系  

Role of proteinuria in in-hospital adverse outcomes in patients with heart failure

作　　者：古振拓 黄至斌[2] 黄惠仪 

机构地区：[1]大朗医院心血管内科,广东东莞523770 [2]中山大学第一附属医院心内科,广州510080 [3]大朗医院电生理室,广东东莞523770

出　　处：《岭南心血管病杂志》2015年第3期357-360,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的 研究心力衰竭患者蛋白尿和住院期间不良事件之间的关系。方法 回顾性分析458例因心力衰竭住院的患者临床资料。根据入院24 h内试纸条法检测的蛋白尿结果判断蛋白尿并分度。结果187例（40.8%）合并蛋白尿,伴蛋白尿患者心源性休克（11.8%vs.4.8%,P=0.006）、使用血管活性药物（10.9%vs.5.5%,P=0.039）和院内死亡（9.6%vs.3.0%,P=0.002）的发生率均高于未伴蛋白尿的患者,差异有统计学意义。在多变量Logistic回归模型中,经年龄、糖尿病、血红蛋白、脑钠肽和估算肾小球滤过率校正后,蛋白尿仍然是心源性休克（OR=1.982,95%CI：1.204~2.432）、使用血管活性药物（OR=1.794,95%CI：1.431~2.004）及院内死亡（OR=2.580,95%CI：1.680~4.101）的独立危险因素。随着蛋白尿的增多,发生不良事件的风险更高。结论心力衰竭患者的蛋白尿是住院期间发生心源性休克、使用血管活性药物以及院内死亡等不良事件的独立危险因素。Objectives To study the role of proteinuria in in-hospital adverse outcomes in patients with heart failure.Methods The clinical data of 458 hospitalized patients with heart failure were investigated postoperatively. Their proteinuria was diagnosed and degraded by dipstick urinalysis within 24 hours of admission. Results Totally 187patients（40.8%） with proteinuria had significantly higher rates of cardiogenic shock（11.8% vs. 4.8%, P =0.006）,use of vasoactive agents（10.9% vs. 5.5%, P =0.039） and in-hospital mortality（9.6% vs. 3.0%, P =0.002） when compared with those without proteinuria. In the multivariate logistic models, after adjustment for age, diabetes,hemoglobin, brain natriuretic peptide and estimated glomerular filtration rate, proteinuria was still associated with cardiogenic shock（OR =1.982, 95% CI ： 1.204-2.432）, use of vasoactive agents（OR =1.794, 95% CI ： 1.431-2.004） and in-hospital mortality（OR=2.580, 95% CI ： 1.680-4.101）. These risks increased with the increasing degree of proteinuria. Conclusions Proteinuria is an independent risk factor for in-hospital adverse outcomes in patients with heart failure, including cardiogenic shock, use of vasoactive agents and in-hospital mortality.

关 键 词：心力衰竭 蛋白尿 危险因素 不良事件 标志物 

分 类 号：R541.6[医药卫生—心血管疾病]