老年慢性心力衰竭患者肾小球滤过功能改变及卡维地洛干预的观察

Prelimininary study on glomerular filtration function and its effect of carvedilol intervention in elderly patients with chronic heart failure

目的评价老年慢性心力衰竭（心衰）患者肾小球滤过功能的变化及卡维地洛对老年慢性心衰患者肾功能的影响。方法入选老年慢性心衰患者47例（慢性心衰组），健康体格检查的非慢性心衰患者22例（非慢性心衰组），分别检测血尿酸（SUA）、血肌酐（Scr），C-G法计算肾小球滤过率（GFR），确定显性肾功能不全（ORI）、隐匿性肾功能不全（CRI）、总肾功能不全（TRI）的发生率。慢性心衰组患者再随机分为卡维地洛组和非卡维地洛组，观察卡维地洛治疗3个月后的左室舒张末内径（LVEDD）、左室射血分数（LVEF）及肾小球滤过功能变化。结果慢性心衰组ORI和TRI发生率均高于非慢性心衰组（ORI分别为55．3％和22．7％，Χ^2=6．43，P〈0．05；TRI分别为80．9％和40．9％，Χ^2=11．01，P〈0．01），但CRI发生率的差异无统计学意义（25．5％和18．1%，Χ^2=0．45，P〉0．05）；慢性心衰组SUA、Scr高于非慢性心衰组[SUA分别为（472．8±100．2）和（415．3±71．4）mmol／L，P〈0．05；Scr分别为（150．7±68．0）和（108．5±43．2）mmol／L，P〈0．01]，GFR低于非慢性心衰组[分别为（42．9±20．7）和（59．3±30．1）ml／min，P〈0．05）]；与治疗前比较，卡维地洛组治疗3个月后的SUA[（407．5±57．7）mmol／L和（476．4±85．2）mmol／L。P〈0．013、Scr[（113．5±55．4）mmol／L和（152．0±74．6）mmol／L，P〈0．01]均显著下降，GFR升高[（57．9±23．7）ml／min和（45．0±22．6）ml／min，P〈0．013；治疗3个月后，卡维地洛组SUA、Scr均显著低于同期的非卡维地洛组（均为P〈0．05），GFR高于非卡维地洛组（P〈0．01）。结论老年慢性心衰患者肾小球滤过功能下降。在充分抗心衰治疗的基础上，加用卡维地洛可以改善慢性心衰患者的肾小球滤过功能。

Objective To investigate the impairment and improving effect of carvedilol on glomerular filtration function in elderly patients with chronic heart failure（CHF）. Methods Forty- seven elderly subjects with CHF（CHF group）, 22 controls without CHF （non-CHF group） were admitted to the research. The levels of serum uric acid （SUA）, creatinine （Scr） and glomerular filtration rate （GFR） were observed, and the incidence rate of obvious renal inadequacy （ORI）and concealed renal inadequacy（CRI） were calculated. In addition, subjects in CHF group were divided into carvedilol treatment group （CAV group, with carvedilol 25.0-37.5 mg daily for 3 months） and non-carvedilol treatment group （non-CAV group）. The changes of left ventricular end diastolic diameter （LVEDD）, left ventricular ejection fraction （LVEF） and parameters reflecting glomerular filtration function were recorded and analyzed. Results （1）The incidence rate of CRI and TRI were higher in CHF group than in non-CHF group （ORI： 51.1%, 22.7%,Χ^2=4.94, P〈0.05;TRI： 80.9%, 40.9%, Χ^2= 11.01, P〈0.01） , but no difference was found in the incidence rate of CRI between the two groups （25.5%, 18.1%, Χ^2= 0.45, P〉0.05） ; （2） SUA and Scr levels in CHF group were all higher than those in non-CHF group [SUA： （472.8± 100.2） mmol/L vs. （415.3± 71.4）mmol/L, P〈0.05;Scr：（150.7±68.0）mmol/L vs. （108.5±43.2）mmol/L, P〈0. 01] ; GFR in CHF group was significantly lower than in non-CHF group （42.9±20.7）vs. （59.3±30.1） ml/min, P〈0.05）. （3）In CAV group, SUA and Scr were decreased [SUA（407.5±57.7）vs. （476.4±85.2） mmol/L, P〈0.01; Scr（113.5 55.4）vs. （152.0 74.6） mmol/L, P〈0. 01] and GFR was increased [（57.9±23.7） ml/min vs. （45.0±22.6） ml/min, P〈0.01] markedly after 3 months of therapy,compared with pre-treatment. In addition, compared with non-CAV group, SUA, Scr were decreased and GFR increased[（57.9± 23.7） vs. （39.6± 16.2） ml/min, P〈0. 01] significantly in CAV group after therapy （all P〈0.05）. Conclusions Glomerular filtration function is decreased in the elderly with CHF. On the bases of sufficient anti-heart failure therapy, third generation of beta- blockercarvedilol might improve glomerular filtration function in the elderly with CHF.