H型高血压与冠心病合并慢性心力衰竭患者肾功能不全的关系

The Relationship of H-type Hypertension and Renal Insufficiency in Coronary Heart Disease Patients with Chronic Heart Failure

目的探讨冠心病合并慢性心力衰竭(CHF)患者中H型高血压与肾功能不全(RI)的关系。方法选取自2011年1月至2013年7月我院收治的100例冠心病合并高血压和CHF的患者为研究对象,所有入选者均合并有肾功能不全。所有入选者均行心脏彩超检查,测定左心室射血分数(LVEF),同时测定入院时血浆脑钠肽(BNP)和血浆同型半胱氨酸(Hcy)水平,并用改良的MDRD公式计算估算的肾小球滤过率(eGFR)。根据Hcy水平将所有患者分为H型高血压组(Hcy≥10μmol/L,n=59)和单纯性高血压组(Hcy<10μmol/L,n=41),比较两组患者的年龄、性别、体质指数(BMI)、LVEF、BNP、心功能分级及eGFR。再以eGFR水平将所有患者分为不同的肾功能状态组,其中CKD 1期19例,2期17例,3期35例,4期29例,比较四组间H型高血压患者比例、LVEF、BNP及Hcy水平。以所有患者的年龄、性别、BMI、是否吸烟、是否合并糖尿病、是否为H型高血压等指标为自变量,以eGFR为因变量,采用多因素Logistic回归分析筛选发生肾功能不全的危险因素。结果 H型高血压组BNP显著高于单纯性高血压组,LVEF显著低于单纯性高血压组,eGFR显著小于单纯性高血压组(P<0.05);不同肾功能状态分组中,CKD分期越高,H型高血压患者所占比例、Hcy及BNP水平显著增加,LVEF显著降低;多因素Logistic回归分析显示,在冠心病合并CHF的患者中H型高血压为发生肾功能不全的危险因子。结论在冠心病合并CHF的患者中,H型高血压与肾功能不全的发生密切相关,且可以作为该类患者发生肾功能不全的危险预测因子。

Aim To discuss the relationship between H-type hypertension and renal insufficiency in patients with coronary atherosclerotic heart disease（ CHD） and chronic heart failure（ CHF）. Methods 100 CHD patients with both hypertension and CHF were chosen in our hospital from January 2011 to July 2013. Left ventricular ejection fraction（ LVEF） was measured with echocardiography and estimated glomerular filtration rate（ eGFR） was calculated with the simplified modification of diet in renal disease（ MDRD） equation in all these patients. Brain natriuretic peptide（ BNP） and plasma homocysteine（ Hcy） were tested when they were first enrolled. According to Hcy level,all the patients were divided into two different groups： H-type hypertension group（ Hcy≥10 μmol /L,n = 59） and simple hypertension group（ Hcy 10 μmol/L,n =41）. Age,gender,body mass index（ BMI）,LVEF,BNP,eGFR and classification of cardiac function were compared between the two groups. Then all patients＇ eGFR were evaluated and classified into different stages according to chronic kidney disease（ CKD） progression,from CKD1 to CKD4,and the percentage of H-type hypertension,LVEF,BNP,Hcy level were all compared between the four different groups. Finally in order to identify the risk factor of renal insufficiency in patients with CHD and CHF,Logistic regression analysis modal was established with the dependent variable-eGFR,and the independent variables,like age,gender,BMI,smoking,diabetes,H-type hypertension.Results Between the H-type hypertension and simple hypertension groups,there were significant differences of BNP,LVEF and eGFR level（ P 0. 05）. Between different CKD stages,the higher the stages were,the higher the percentage of H-type hypertension and the Hcy level could be,also the worse the cardiac function could became. Multiple Logistic regression analysis indicated that,in addition to age and diabetes,H-type hypertension was a risk factor for renal insufficiency in patients with CHD and CHF. Conclusion H-type hypertension was closely related to renal insufficiency in patients with CHD and CHF,and could be a risk factor to predict the occurrence of renal insufficiency in this kind of patients.