心力衰竭患者血脂与肌酐清除率的相关性研究

Correlation between blood lipids level with creatinine clearance rate in patients with heart failure

目的：探讨心力衰竭（心衰）患者血脂与肌酐清除率（Ccr）水平的相关性。方法收集2010年1月—2013年6月天津医科大学第二医院心内科出院诊断为心衰（心功能分级NYHAⅡ~Ⅳ级）的955例患者作为心衰组，选择心功能正常且与心衰组情况大致匹配的200例查体者为对照组。将心衰组根据心功能分级分为Ⅱ、Ⅲ、Ⅳ级；根据Ccr水平分为正常组、肾功能轻度损伤组、肾功能中重度损伤组；并根据性别进行分组，比较各组血脂水平。采用二分类Logistic回归分析心衰患者肾功能的影响因素。结果与对照组相比，心衰组三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-c）、非高密度脂蛋白胆固醇（non-HDL-c）水平升高，Ccr、高密度脂蛋白胆固醇（HDL-c）水平降低。心衰组不同心功能分级间比较，心功能Ⅳ级的心衰患者Ccr及血脂各项指标降低。不同肾功能组间比较，肾功能中重度损害组TG、HDL-c水平降低。不同性别组间比较，女性组各项血脂水平均比男性组增高（P〈0.05或P〈0.01）。Logistic回归显示年龄高、冠心病、高血压是心衰患者肾功能损害的危险因素，体质量增加、HDL-c升高是保护因素。结论心衰患者的血脂水平影响肾功能，在控制心衰患者血脂水平的同时要注意保护肾功能。

Objective To explore the relationship between blood lipids level with creatinine clearance rate（Ccr）in patients with heart failure（HF）. Methods A total of 955 patients who were diagnosed with heart failure（cardiac function NYHAⅡ~Ⅳclassification）upon discharge from the Department of Cardiology of the Second Hospital of Tianjin Medical University, between January 2010 to June 2013 were enrolled as HF group. Healthy adults （n=200） with normal cardiac function which approximately matched basic condition with HF group were selected as control group. The HF group was fur？ther divided intoⅡ,Ⅲ,Ⅳclassification according to their cardiac function（NYHA classification）. HF group was also divid？ed into normal renal function group, mild renal injury group and moderate-severe renal injury group based on their Ccr. Ef？fect of gender and lipid parameters were also compared. Binary logistic regression was used to analyze factors influencing renal function in patients with HF. Results Compared with people in the control group, the levels of triacylglycerol（TG）, total cholesterol（TC）, low density lipoprotein cholesterol（LDL-c）and non high density lipoprotein cholesterol（non-HDL-c）in patients of HF group were increased while Ccr and high density lipoprotein cholesterol（HDL-c）were decreased. Ccr and lipids were obviously decreased in patients with HF of Ⅳclassification. TG and HDL-c were decreased in moderate-severe renal injury group. Females had a higher lipid levels than males in HF group（P〈0.05 or P〈0.01）. Advanced age, coronary heart disease and hypertension were all risk factors for renal impairment in patients with HF by binary logistic re？gression. On the other hand, weight gain and HDL-c were the protection factors for renal function in HF patients. Conclu？sion Dyslipidemias may lead to renal insufficiency in patients with HF. It was important to control lipids and improve re？nal function in patients with HF.