血清尿素氮水平对心力衰竭患者院内死亡的评估价值  

Value of serum urea nitrogen on in-hospital death in patients with heart failure

作　　者：王传合[1] 李影[1] 韩苏[1] 佟菲 李志超 崔文佳 孙志军[1] Wang Chuanhe;Li Ying;Han Su;Tong Fei;Li Zhichao;Cui Wenjia;Sun Zhijun(Department of Cardiology,Shengjing Hospital of China Medical University,Shenyang 110022,China)

机构地区：[1]中国医科大学附属盛京医院心血管科,沈阳110022

出　　处：《中国医师进修杂志》2020年第7期590-595,共6页Chinese Journal of Postgraduates of Medicine

基　　金：辽宁省科学技术计划(2018225003)。

摘　　要：目的探讨血清尿素氮水平对心力衰竭患者院内死亡的评估价值。方法回顾性分析中国医科大学附属盛京医院2013年1月至2018年12月9459例心力衰竭患者的临床资料。其中,发生院内死亡296例(死亡组),未发生院内死亡9163例(存活组)。收集患者的临床资料,包括一般情况、既往疾病史、体格检查、实验室检查及相关物理检查等。相关性采用Pearson相关分析;采用多因素Logistic回归分析确定影响心力衰竭患者院内死亡的独立危险因素;绘制受试者工作特征(ROC)曲线,确定尿素氮预测心力衰竭患者院内死亡的最佳界值。结果心力衰竭患者院内病死率为3.1%(296/9459)。死亡组和存活组年龄、高血压率、糖尿病率、心房颤动史率、吸烟史率、血红蛋白、白蛋白、糖化血红蛋白、尿素氮、肌酐、尿酸、血清钾、血清钠、肌钙蛋白I、N末端脑利钠肽前体(NT-proBNP)、左室射血分数(LVEF)比较差异有统计学意义(P<0.01或<0.05);两组性别构成、冠心病率、血小板、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、三酰甘油、左室舒张末期容积(LVEDV)和左室收缩末期容积(LVESV)比较差异无统计学意义(P>0.05)。Pearson相关分析结果显示,尿素氮与年龄、冠心病、高血压、糖尿病、糖化血红蛋白、肌酐、尿酸、血清钾、肌钙蛋白I、NT-proBNP、LVEDV、LVESV呈正相关(r=0.130、0.024、0.053、0.128、0.033、0.739、0.468、0.377、0.065、0.432、0.084、0.101,P<0.01或<0.05),与性别、心房颤动史、血红蛋白、血小板、白蛋白、总胆固醇、LDL-C、血清钠、LVEF呈负相关(r=-0.033、-0.063、-0.272、-0.077、-0.188、-0.070、-0.071、-0.199、-0.113,P<0.01),与吸烟史、三酰甘油无相关性(P>0.05)。多因素Logistic回归分析结果显示,年龄、高血压、白蛋白、尿素氮、肌钙蛋白I和NT-proBNP是影响心力衰竭患者院内死亡的独立危险因素(OR=1.018、0.613、0.924、1.082、1.340和1Objective To investigate the value of serum urea nitrogen on in-hospital death in patients with heart failure.Methods The clinical data of 9459 patients with heart failure from January 2013 to December 2018 in Shengjing Hospital of China Medical University were retrospectively analyzed.Among them,296 cases died in hospital(death group)and 9163 cases survived(survival group).The clinical data of patients were collected,including general condition,disease history,physical examination,laboratory indicators and relevant physical examination,etc.Correlation was finished with Pearson correlation analysis.Multivariate Logistic regression analysis was used to determine independent risk factors for in-hospital death in patients with heart failure.Receiver operating characteristic(ROC)curve was used to determine the optimal predictive threshold of urea nitrogen for in-hospital death.Results The in-hospital mortality in patients with heart failure was 3.1%(296/9459).There were statistical differences in age,hypertension rate,diabetes rate,a history of atrial fibrillation rate,smoking history rate,hemoglobin,albumin,glycosylated hemoglobin,urea nitrogen,creatinine,uric acid,serum potassium,serum sodium,troponin I,N terminal brain natriuretic peptide precursor(NT-proBNP),left ventricular ejection fraction(LVEF)between death group and survival group(P<0.01 or<0.05),and there were no statistical difference in gender composition,coronary heart disease rate,platelet,total cholesterol,low-density lipoprotein cholesterol(LDL-C),triglyceride,left ventricular end-diastolic volume(LVEDV)and left ventricular end-systolic volume(LVESV)between 2 groups(P>0.05).Pearson correlation analysis result showed that the urea nitrogen was positively correlated with age,coronary heart disease,hypertension,diabetes,glycosylated hemoglobin,creatinine,uric acid,serum potassium,troponin I,NT-proBNP,LVEDV and LVESV(r=0.130,0.024,0.053,0.128,0.033,0.739,0.468,0.377,0.065,0.432,0.084 and 0.101;P<0.01 or<0.05);and the urea nitrogen was negatively correlate

关 键 词：心力衰竭 血尿素氮 医院死亡率 回顾性研究 

分 类 号：R541.6[医药卫生—心血管疾病]