老年人慢性心力衰竭早期肾功能损害的临床观察

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

目的 探讨老年人慢性心力衰竭（CHF）患者早期肾功能损害及其与心功能的关系。方法 测定40例60～80岁的CHF患者、40例同年龄的心功能代偿的心脏病患者及40例同年龄的健康对照者的常规尿蛋白（UP）、血清／尿肌酐（S／UCr）、尿素氮（BUN）、尿微量白蛋白（UMA）、尿β2-微球蛋白（Uβ2-MG）水平。并与左心室射血分数（LVEF）进行相关分析。结果 老年CHF患者UMA水平较健康对照组和心功能代偿的心脏病组明显升高[分别为（8．69±10．23）、（1．72±1．25）和（2．30±2．08）mg／mmool UCr]，差异有统计学意义（均为P〈0．01）；与LVEF呈显著负相关（r=-0．36，P〈0．01）；Uβ2-MG3组分别为（0．143±0．223）mg／mmool UCr、（0．135±0．215）mg／mmool UCr和（0．146±0．249）mg／mmool UCr，差异无统计学意义（均为P〉0．05）。结论 老年CHF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；CHF程度越重，肾小球滤过功能损害越明显。

Objective To investigate the relationship between the early renal function impairment and chronic heart failure （CHF） in elderly patients. Methods The levels of routine urine protein （UP）,serum/urine creatinine （S/UCr）, blood urea nitrogen （BUN）, urine microablumin （UMA） and beta-2-microglobulin （Uβ2-MG） were measured in 40 elderly patients （≥60 years old） with CHF, 40 elderly patients with cardiovascular diseases and compensated heart functions, and 40 elderly normal volunteers. Results The elderly CHF patients with normal levels of UP, SCr and BUN had higher level of UMA than did the healthy control and compensated heart function groups [（8. 69±10. 23）, （1.72±1.25）, （2.30±2.08）mg/mmol UCr, respectively, all P〈0.01]. And the level of UMA was negatively correlated with left ventricular election fraction（r=-0. 36, P〈0.01）. There was no difference in Uβ2-MG among the three groups[（0. 14±0. 223） vs （0. 135±0. 215）and （0. 146±0. 249） mg/mmol UCr （all P〉 0.05）]. Conclusions The early abnormality of renal function in elderly patients with CHF is featured by impaired glomerular filtration function. The more severe the heart failure,the more significant the glomerular filtration function impairment.