不同肾功能评价指标对慢性心力衰竭患者远期预后的预测价值  

Predictive value of different renal function indexes to long-term prognosis in patients with chronic heart failure

作　　者：李雨濛 胡元会[2] 商秀洋[2] 宋庆桥[1] 吴华芹[2] 张并璇[1] Li Yumeng;Hu Yuanhui;Shang Xiuyang;Song Qingqiao;Wu Huaqin;Zhang Bingxuan(Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China;不详)

机构地区：[1]中国中医科学院广安门医院综合科,北京100053 [2]中国中医科学院广安门医院心血管科,北京100053

出　　处：《中国循证心血管医学杂志》2020年第7期816-819,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：国家自然科学基金面上项目(81573799);中国中医科学院广安门医院所级课题(2018S420)。

摘　　要：目的比较不同肾功能评价指标在慢性心力衰竭(CHF)患者远期生存中的预测价值。方法选取2006年1月至2014年8月于中国中医科学院广安门医院心内科住院的CHF患者546例为研究对象,随访周期为730 d,终点事件为全因死亡。根据是否发生终点事件将546例患者分为两组:非终点事件组337例(69.0%)和终点事件组169例(31.0%)。采用受试者工作曲线(ROC)评价估算的肾小球滤过率(eGFR)、血肌酐(SCr)和血尿素氮(BUN)对CHF全因死亡的预测能力;选择各指标的最佳切点值进行分组,以Kaplan-Meier生存曲线描述各组生存率;采用多因素Cox回归模型分析不同肾功能指标与远期预后的相关性。结果共纳入CHF患者546例,其中资料完整者392例,未完成随访者154例。eGFR、SCr和BUN的ROC曲线下面积分别为0.631、0.633和0.706,最佳切点值分别为58.61 ml/(min·1.73 m^2)、113.75μmol/L和7.41 mmol/L。Kaplan-Meier生存曲线显示,eGFR降低组、SCr升高组和BUN升高组患者全因死亡风险更高(P<0.001)。校正年龄、性别、心功能等因素后,BUN是CHF全因死亡的独立危险因素(HR=1.043,95%CI:1.007~1.082,P<0.001)。结论eGFR、SCr和BUN对CHF远期预后具有预测价值,其中BUN是CHF全因死亡的独立危险因素。Objective To compare the predictive value of different renal function indexes to long-term prognosis in patients with chronic heart failure(CHF).Methods CHF patients(n=546)were chosen from Department of Cardiology in Guang’anmen Hospital of China Academy of Chinese Medical Sciences from Jan.2006 to Aug.2014.The follow-up period was 730 d and end-point event was all-cause death.All 546 patients were divided,according to occurrence of end-point event,into non-end-point event group(n=337,69.0%)and end-point event group(n=169,31.0%).The predictive power of estimated glomerular filtration rate(eGFR),serum creatinine(SCr)and blood urea nitrogen(BUN)to all-cause death of CHF was reviewed by using receiver operating curve(ROC).The patients were divided again into groups according to the optimal cut-point values of different indexes,and survival rate was described by using Kaplan-Meier survival curve.The correlation between different renal function indexes and long-term prognosis was analyzed by applying multi-factor Cox regression model.Results There were totally 546 CHF patients included,and among them 392 had complete materials and 154 had incomplete follow-up.The area under ROC of eGFR was 0.631,that of SCr was 0.633 and that of BUN was 0.706.The optimal cut-point value of eGFR was 58.61 ml/(min·1.73 m^2),that of SCr was 113.75μmol/L and that of BUN was 7.41 mmol/L.The results of Kaplan-Meier survival curve analysis showed that the risk of all-cause death was higher in decreased eGFR group,increased SCr group and increased BUN group(P<0.001).After correcting age,sex and heart function,BUN was an independent risk factor of all-cause death of CHF(HR=1.043,95%CI:1.007~1.082,P<0.001).Conclusion The indexes including eGFR,SCr and BUN have predictive value to longterm prognosis in CHF patients,and BUN is an independent risk factor of all-cause death of CHF.

关 键 词：慢性心力衰竭 肾功能 远期预后 

分 类 号：R541.61[医药卫生—心血管疾病]