慢性心力衰竭患者早期肾损害的临床研究

Early impairment of renal function in chronic heart failure and its clinical significance

目的观察慢性心力衰竭(心衰)患者尿微量蛋白变化及其与心功能的关系。方法测定25例心衰患者、22例心功能代偿的心脏病患者及20例健康对照的常规尿蛋白(UP)、血清肌酐(Cr)、尿素氮(BUN)、尿微量白蛋白(MA)、尿免疫球蛋白IgG(UIgG)、尿视黄醇结合蛋白(URbp)、尿β2微球蛋白(Uβ2MG)水平,并与左室射血分数(EF)等进行相关分析。结果UP、Cr、BUN正常的心衰病人MA、UIgG水平较正常对照和心功能代偿的心脏病患者明显增高[(7.49±10.47)mg/mmolCr比(1.19±0.85)mg/mmolCr和(1.63±1.62)mg/mmolCr;(0.82±1.47)mg/mmolCr比(0.27±0.15)mg/mmolCr和(0.40±0.49)mg/mmolCr;P<0.01;P<0.05],并与EF呈显著性负相关(r=-0.31,r=-0.40,P<0.01);URbp、Uβ2MG三组间差异无统计学意义。结论无原发性肾脏病变的心衰患者存在以肾小球滤过功能受损为特征的早期肾功能异常;心衰程度愈重,肾功能损伤愈明显。

Objective To observe the changs of the microproteinuria(MA) and the relationship in patients with chronic heart failure(CHF).Methods Routine urine protein, blood creatinine and urea nitrogen and MA, immunoglobulin G(UIgG), retinal-binding protein(URbp) and beta-2 -mocroglobulin(Uβ 2-MG) were measured and analyzed in 25 patients with CHF, 22 patients with cardiovascular diseases but compensated heart function s and 20 normal volunteers. Results The levels of Ualb and UIgG in the CHF group were significantly higher than those in the normal group and compensated heart function group[(7.49±10.47) mg/mmolCr vs (1.19±0.85) mg/mmolCr and (1.63±1.62) mg/mmolCr; (0.82±1.47) mg/mmolCr vs (0.27±0.15) mg/mmolCr and (0.40±0.49) mg/mmolCr; P<0.01; P<0.05; respectively] and they were negatively correlated with left ventricular ejection fraction(r=-0.31, r=-0.40, P<0.01). There were no significant difference of URbp and Uβ 2-MG among the above three groups.Conclusions There is early abnormality of renal function in CHF patients without primary renal disorder and the abnormality was featured by impaired glomerular filtration function. The more severe the heart failure, the more significant the renal function impairment.