缺血性心肌病合并慢性肾脏病住院患者的临床特点  

Clinical characteristics of hospitalized patients with ischemic cardiomyopathy complicated with chronic kidney disease

作　　者：吴泽佳 蔡安平[2,3] 徐兰 陈文中 丘伟达 肖小菊 夏爽 何旭瑜 黎励文[2,3] WU Ze-jia;CAI An-ping;XU Lan;CHEN Wen-zhong;QIU Wei-da;XIAO Xiao-ju;XIA Shuang;HE Xu-yu;LI Li-wen(Affiliated Dongguan People′s Hospital Southern Medical University,Dongguan,Guangdong 523000,China;Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510100,China;Guangdong Cardiovascular Institute,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,510100,China;Huizhou Third People′s Hospital,Huizhou,Guangdong 516002,China)

机构地区：[1]南方医科大学附属东莞人民医院,广东东莞512000 [2]广东省人民医院(广东省医学科学院),广州510100 [3]广东省心血管病研究所广东省人民医院(广东省医学科学院),广州510100 [4]惠州市第三人民医院,广东惠州516002

出　　处：《岭南心血管病杂志》2021年第4期478-485,共8页South China Journal of Cardiovascular Diseases

基　　金：广东省冠心病防治研究重点实验室项目(项目编号:2017B030314041);高层次人才团队建设项目(项目编号:Y012018085);广东省医学科学技术研究项目(项目编号:A2017293);2019年国自然配套启动经费项目(项目编号:K19010101)。

摘　　要：目的探讨缺血性心肌病合并慢性肾脏病(chronic kidneydisease,CKD)患者的临床特点及其对临床决策、住院时间、院内死亡的影响。方法对2015年12月至2019年6月于广东省人民医院住院的年龄≥18岁的缺血性心肌病患者进行回顾性分析。将患者分为CKD组和非CKD组,对两组患者的体格检查结果、实验室指标、心脏超声指标、并发症、临床用药、住院时间、院内病死率等进行比较。结果共分析了1599例缺血性心肌病患者[其中CKD患者441例(27.6%)]。与非CKD组患者比较,CKD组患者年龄更大,男性比例、体质量指数更低,心力衰竭相关症状体征患者比例更高;因心力衰竭入院患者比例更高,因急性冠状动脉综合征入院患者比例更低;实验室检查结果显示血尿酸、血钾、N末端B型利钠肽原浓度更高,血红蛋白、白蛋白浓度更低;心脏超声检查结果发现室间隔更厚,左心房更大,肺动脉压更高,二尖瓣反流比例更高,左心室射血分数明显降低;室性心律失常患者比例更高;合并心力衰竭、原发性高血压(高血压)、糖尿病、贫血、室性心动过速、慢性阻塞性肺疾病、高钾血症患者比例更高;院内使用静脉强心药、静脉利尿药患者比例更高;院内植入支架的患者比例更低;出院时使用利尿剂、醛固酮受体拮抗剂、地高辛、钙离子拮抗剂患者比例更高,而使用阿司匹林、氯吡格雷/替格瑞洛、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂/血管紧张素受体脑啡肽酶抑制剂、β受体阻断药的患者比例明显降低;住院时间延长,院内病死率增高,差异均有统计学意义(P>0.05)。结论在缺血性心肌病患者中,合并CKD的患者年龄更大,并发症更多,心力衰竭的比例更高,相应使用利尿剂及强心药的比例更高,但是指南指导的药物治疗比例反而降低,住院时间延长,院内病死率增高。Objectives To investigate the clinical characteristics of ischemic cardiomyopathy patients with chronic kidney disease(CKD)and its influence on clinical decision,hospital stay and hospital death.Methods The patients with ischemic cardiomyopathy and aged≥18 years who were hospitalized in Guangdong Provincial People′s Hospital from December 2015 to June 2019 were analyzed retrospectively.The patients were divided into CKD group and non CKD group.The physical examination,laboratory indexes,cardiac ultrasound indexes,complications,clinical medica⁃tion,hospital stay and hospital mortality between CKD group and non-CKD group were compared.Results A total of 1599 patients with ischemic cardiomyopathy were analyzed,among them,441(27.6%)patients with CKD.Compared with non-CKD group,patients in CKD group were older;had a lower proportion of male,lower body mass index;higher proportion of symptoms and signs related to heart failure;higher proportion of admissions due to heart failure and lower proportion of admissions due to acute coronary syndrome;higher concentrations of uric acid,serum potassium,and N-terminal Pro-B-type natriuretic peptide,lower concentrations of hemoglobin and albumin;thicker interventricular septum,larger left atrium,higher pulmonary artery pressure;higher proportion of mitral regurgitation;lower left ventricular ejection fraction;higher proportions of combining ventricular arrhythmia,heart failure,hypertension,diabetes,anemia,ventricular tachycardia,chronic obstructive pulmonary disease,and hyperkalemia;higher proportion of intravenous cardiotonic drugs and intravenous diuretics;lower proportion of stents implanted in the hospital;higher proportions of diuretics,aldosterone receptor antagonists,digoxin and calcium antagonists when discharged;lower proportions of aspirin,clopidogrel/ticagrelor,angiotensin-converting enzyme inhibitors/angiotensinⅡreceptor antago⁃nists/angiotensin receptor enkephalin inhibitors,β-receptor blockers;longer hospitalization duration and higher hospital mortality.

关 键 词：心肌病 冠状动脉疾病 左心功能不全 慢性肾脏病 

分 类 号：R542[医药卫生—心血管疾病]