蛋白尿对心力衰竭患者不良危重事件及预后的预测价值  

Predictive value of proteinuria for in-hospital severe adverse events and prognosis of the patients with heart failure

作　　者：柳学[1] 李志莲[2] 曾文新[1] 何楷然[1] 甄向凡 黄澄[1] 梁馨苓[2] 

机构地区：[1]广东省医学科学院 广东省人民医院急危重症医学部,广州510080 [2]广东省医学科学院 广东省人民医院肾内科,广州510080

出　　处：《中华医学杂志》2016年第30期2404-2409,共6页National Medical Journal of China

基　　金：国家自然科学基金（81570609、81200544）

摘　　要：目的探讨蛋白尿对心力衰竭患者住院期间不良危重事件及预后的预测价值。方法回顾性分析520例住院心力衰竭（HF）患者（纽约心脏病协会NYHA分级为3～4级）的临床资料。根据入院时首次尿试纸法检测的结果判断蛋白尿并分级。比较分析蛋白尿和无蛋白尿患者两组间的临床特点，单变量和多变量Logistic回归分析蛋白尿与临床不良危重事件及预后的相关性。结果 入院时心力衰竭患者57.7%（300/520）合并蛋白尿。合并蛋白尿的HF患者，年龄更大，合并高血压（199例与122例）、糖尿病（120例与50例）和贫血（169例与97例）的比例更高，N末端脑钠肽原（NT－proBNP）、血清肌酐值、C－反应蛋白和空腹血糖水平更高，住院时接受血管活性药物的比例更高，eGFR、血红蛋白和红细胞压积更低，差异均有统计学意义。多变量分析显示，蛋白尿是HF患者机械通气（OR＝2.916, 95% CI： 1.712～4.968, P〈0.001）、心肺复苏（OR＝1.956, 95% CI： 0.997～3.843, P＝0.049）和院内死亡（OR＝2.490, 95% CI： 1.188～5.218, P＝0.016）的独立危险因素。结论 住院心力衰竭患者中，合并蛋白尿的患者病情严重，蛋白尿是肾替代治疗、机械通气、心肺复苏和院内死亡的独立危险因素，是一种能反映HF患者危重不良事件和预后的潜在指标。ObjectiveTo investigate the effect of proteinuria on in-hospital severe adverse events and prognosis of the patients with heart failure（HF）.MethodsClinical data of 520 patients with severe HF（ NYHA 3-4 grades） in our department were analyzed retrospectively. Proteinuria was diagnosed on admission using the spot dipstick urinalysis. Clinical characteristics were compared between the patients with and without proteinuria. Univariate and multivariate Logistic regression analysis were used to evaluate the correlations of proteinuria with in-hospital adverse events and prognosis.ResultsOn admission, proteinuria was found in 57.7% （300/520） of the enrolled patients with severe HF. The age, proportions of the HF patients coexistent with hypertention, diabetes mellitus and aneamia, and receiving vasoactive drugs, levels of NT-proBNP, creatinine, C-reactive protein and fasting blood glucose, were significantly higher, while the levels of eGFR, hemoglobin and hematocrit significantly lower in the proteinuria group than those in the non- proteinuria group. The multivariate analysis revealed that proteinuria was an independent risk factor for mechanical ventilation （MV） （OR=2.916, 95% CI： 1.712-4.968, P〈0.001）, cardiopulmonary resuscitation （CPR） （OR=1.956, 95% CI： 0.997-3.843, P=0.049） and in-hospital mortality （OR=2.490, 95% CI： 1.188-5.218, P=0.016）.ConclusionsThe severe HF patients with proteinuria often present with severe critical conditions. Proteinuria should be a potential marker for in-hospital adverse events and prognosis of severe hospitalized HF patients.

关 键 词：心力衰竭 蛋白尿 慢性肾脏病 危重症标志物 危险因素 

分 类 号：R541.6[医药卫生—心血管疾病]