慢性心力衰竭不同分级的肾小球率过滤及同型半胱氨酸水平的观察分析

Clinical observation of the glomerular filtration rate and homocysteine levels of chronic heart failure of different grading

目的通过观察分析慢性心力衰竭(CHF)不同分级的患者肾小球滤过率(GFR)水平及同型半胱氨酸(Hcy)水平,进一步探讨GFR及Hcy在心力衰竭患者中的临床意义。方法收集CHF患者与对照组的病例资料,按照NYHA心功能分级分为Ⅰ、Ⅱ、Ⅲ、Ⅳ级,4组病例数分别为15、103、123、80例。选取无心力衰竭且年龄性别相当的患者30例作为对照组。记录血肌酐(SCr)和血尿素氮(BUN)、Hcy等指标。应用MDRD方程和简化MDRD方程来估算每个患者的肾小球滤过率(GFR)。采用SPSS 15.0软件包进行统计学分析。结果 MDRD方程和简化MDRD方程计算出的GFR水平在对照组、心功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级组中逐渐降低;MDRD方程和简化MDRD方程中的心功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级组GFR水平,分别与对照组比较差异均有统计学意义(P<0.05)。对照组、心功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级组中Hcy水平逐渐升高;心功能Ⅲ、Ⅳ级组Hcy水平,分别与对照组比较差异均有统计学意义(P<0.05)。结论进一步验证了肾功能不全已经成为CHF患者死亡的一种独立的预测因素,GFR水平及Hcy水平检测可用来判定慢性心力衰竭患者的早期肾功能减退程度。

Objective Through the observation and analysis of the GFR level and Hcy level in different stage of chronic heart failure cardiac function,further to discusse the significance of GFR and Hcy in the heart failure patients.Methods Collect the information of CHF patients and control group patients.The patients were divided into 4 groups according to the New York Heart Association（NYHA）criteria,The number of NYHA I、II、III、IV was 15、103、123、80 respectively,30 patients who did not have heart failure were involved as control group.Rcords creatinine（SCr）、blood urea nitrogen（BUN）and homocysteine（Hcy）index.Application MDRD equation and simplified MDRD equation to estimate each patient estimated glomerular filtration rate（GFR）.A statistical software package（SPSS 15.0）were employed for data analyze.Results The GFR estimated by MDRD and simplified MDRD formula decreased in control group,NYHA I group,NYHA II group,NYHA III group,NYHA IV group.There is significant difference between control group and NYHA I group,NYHA II group,NYHA III group,NYHA IV group（P＆lt;0.05）.The Hcy raised in control group,NYHA I group,NYHA II group,NYHA III group,NYHA IV group.There is significant difference between control group and NYHA III group,NYHA IV group（P＆lt;0.05）.Conclusion Further verified renal dysfunction has become an independent predictor in the death of chronic heart failure patients.