尿白蛋白水平及螺内酯对左室射血分数保留的心衰患者的预后影响

The Relationship Between Albuminuria or Spironolactone and Heart Failure with Preserved Ejection Fraction

目的:评估白蛋白尿对左室射血分数保留的心衰(heart failure with preserved ejection fraction,HFpEF)患者预后作用,并进一步评估螺内酯在减少该人群中白蛋白尿中的作用。方法:本研究连续收集2014年1月至2016年12月在我院心血管内科住院的331例HFpEF患者。并收集患者基线白蛋白与尿肌酐比值(urinary albumin:creatinine ratio,UACR)与临床资料。通过Cox多元回归分析计算风险比(HRs),得出UACR与终点事件(包括全因死亡、心衰再住院和高钾血症)的关系,并进一步对比分析UACR组内使用与非使用螺内酯1年后尿白蛋白变化情况。结果:本研究纳入合并白蛋白尿HFpEF患者180例,无白蛋白尿患者151例。UACR组具有较多男性,β-受体阻滞剂使用、糖尿病病史、慢性肾功能不全病史、而且收缩压较高,均有统计学差异(p<0.05)。尿白蛋白与复合终点独立密切相关,其风险比为1.54(95%CI,1.12-2.13,P=0.020)。170例UARC患者随访期间返院复查UACR。对于其中使用螺内酯的131患者,1年后尿白蛋白下降42%,明显高于非螺内酯组。。结论:在HFpEF患者中,尿白蛋白增加会导致主要不良心血管事件。螺内酯显著减少HFpEF患者白蛋白尿,并有望改善HFpEF远期临床获益。

Objective: To evaluate the predictive effect of Albuminuria in heart failure with preserved ejection fraction (HFpEF) and the therapies effect of spironolactone to reduced albuminuria in HFpEF. Methods: 331 consecutive HFpEF patients were enrolled from Jan 2014 to Dec 2016 in our center. Data including urinary albumin: creatinine ratio (UACR) were collected. We examined the association of UACR with the primary outcome (all-cause death, heart failure hospitalization and Hyperkalemia) using multivariable-adjusted Cox regression and evaluated whether spironolactone reduced albuminuria at the 1-year visit.Results 180 HFpEF cases with albuminuria and 151 HFpEF cases was enrolled in this study. UACR was associated with male sex, higher systolic blood pressure, diabetes mellitus, renal dysfunction, and more β-blocker therapy. Albuminuria was independently associated with the primary end point (HR 1.54, 95%CI 1.12-2.13,P=0.020). In 170 cases of UACR group, spironolactone reduced albuminuria by 42% in all participants at the 1-year visit compared with baseline much more than other group Conclusions: Albuminuria was independently associated with worse cardiovascular outcomes. Spironolactone significantly reduced albuminuria and might be associated with improved outcomes.