CKD-EPI公式法测定肾小球滤过率对射血分数减低心力衰竭患者心脏性猝死的预测价值  

Predictive value of glomerular filtration rate calculated by CKD-EPI formula for sudden cardiac death in heart failure patients with reduced ejection fraction

作　　者：赵爽 樊晓寒 陈柯萍 戴研 李晓瑶 周彬 张澍 Zhao Shuang;Fan Xiaohan;Chen Keping;Dai Yan;Li Xiaoyao;Zhou Bin;Zhang Shu(Center of Arrhythmia,Fuwai Hospital,State Key Laboratory of Cardiovascular Disease,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院、北京协和医学院、国家心血管病中心、心血管疾病国家重点实验室、阜外医院心律失常中心,北京100037

出　　处：《中华心律失常学杂志》2022年第6期547-552,共6页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的探讨通过CKD-EPI公式法测定的肾小球滤过率(GFR)与射血分数减低心力衰竭(心衰)患者的心脏性猝死(SCD)及全因死亡的关系。方法本研究为单中心回顾性非随机病例对照研究,回顾性分析了2013年2月至2015年11月就诊于中国医学科学院阜外医院的左心室射血分数(LVEF)减低(<40%)的心衰患者。通过CKD-EPI公式计算GFR,并根据结果将患者分为3组:A组,GFR≥90 ml·min·(173m^(2))^(-1),肾功能正常;B组,GFR为60~89 ml·min·(173m2)-1,轻度肾功能异常;C组,GFR<60 ml·min·(173m^(2))^(-1),中重度肾功能异常。所有患者通过门诊或电话访问进行定期随访(6个月,1、2、3年),并比较3组患者之间的临床特征、超声心动图及血生化等指标。主要研究终点是SCD,次要研究终点是全因死亡。结果共入选303例患者,年龄(55.58±14.72)岁,其中男占80.9%(245/303),随访(25.84±13.95)个月,共45例14.9%(45/303)患者发生SCD,30.4%(92/303)患者发生全因死亡。K-M生存曲线分析结果显示,与A组(88例)相比,C组(86例)SCD(Log-rank P<0.001)、全因死亡(Log-rank P=0.018)风险均显著升高,B组(129例)SCD(Log-rank P=0.064)风险较A组升高,差异处于统计学边缘。多因素Cox分析结果显示,以A组作为参照组,GFR<60 ml·min·(173m^(2))^(-1)(C组)是SCD的独立危险因素(HR=6.271,95%CI 1.684~20.006,P=0.004)及全因死亡的独立危险因素(HR=1.983,95%CI 1.024~3.84,P=0.042)。结论通过CKD-EPI公式计算的GFR对射血分数减低的心衰患者SCD及全因死亡的发生风险有较好的预测价值,可作为心衰患者SCD风险及全因死亡的危险分层因子。Objective To investigate the association between determination of glomerular filtration rate(GFR)by CKD-EPI formula and sudden cardiac death(SCD)and all-cause mortality in heart failure patients with reduced ejection fraction(HFrEF).Methods This was a single-center,retrospective,non-randomized case-control study.Patients with HFrEF in Fuwai Hospital from February 2013 to November 2015 were analyzed retrospectively.The GFR was calculated by the CKD-EPI formula,and the patients were divided into three groups according to GFR.Group A,GFR≥90 ml·min·(173m^(2))^(-1),normal renal function(n=88);Group B,GFR 60-89 ml·min·(173m^(2))^(-1),mild renal dysfunction(n=129);Group C,GFR<60 ml·min·(173m^(2))^(-1),moderate to severe renal dysfunction(n=86).All patients were followed up regularly(6 months,1 year,2 years and 3 years)through outpatient or telephone interviews.Clinical characteristics,echocardiography and blood biochemical indicators were compared among the 3 groups.The primary endpoint was sudden cardiac death(SCD),and the secondary endpoint was all-cause mortality.Results A total of 303 patients were enrolled.The average age was(55.58±14.72)years old and 80.9%(245/303)of them were males.During a mean follow-up period of(25.84±13.95)months,45 patients(14.9%,45/303)experienced SCD and 92 patients(30.4%,92/303)died.Kaplan-Meier survival curve analysis showed that compared with group A,the risk of SCD(Log-rank P<0.001)and all-cause mortality(Log-rank P=0.018)were significant higher in group C.The risk of SCD in group B(Log-rank P=0.064)was higher than that in group A,however,the difference was at the edge of statistics.Multivariate Cox regression analysis showed that with group A as the reference group,GFR<60 ml·min·(173 m^(2))^(-1)(group C)was an independent risk factor for SCD(HR=6.271,95%CI 1.684-20.006,P=0.004)and for all-cause mortality(HR=1.983,95%CI 1.024-3.84,P=0.042).Conclusion The GFR calculated by CKD-EPI formula has a good predictive value for the risk of SCD and all-cause mortality in HFrEF patien

关 键 词：肾小球滤过率 CKD-EPI公式法 射血分数减低心力衰竭 心脏性猝死 全因死亡 

分 类 号：R541.6[医药卫生—心血管疾病]