射血分数正常的心力衰竭老年患者的肾功能改变及其临床意义

Changes of Renal Function in Elderly Patients with Heart Failure but Normal Ejection Fraction and Its Clinical Significance

目的观察射血分数正常的心力衰竭(HFPEF)老年患者的肾功能指标及其临床意义。方法选取2014年1月至2014年10月中国医科大学附属第一医院老年心内科患者145例,以冠心病为主要诊断标准,根据是否存在HFPEF分为HFPEF组(65例)和非HFPEF组(80例),对所有患者行心彩超、BNP及肾功检查,并计算肾小球滤过率(GFR)。结果 HFPEF组患者平均年龄较非HFPEF组增大(P<0.001),患者高血压、糖尿病、冠心病、房颤或者同时合并2种及以上疾病的发生率较非HFPEF组显著升高(P值分别为0.046、<0.001、0.002、0.021、<0.001)。2组患者GFR水平均低于正常值水平,与非HFPEF组比较,HFPEF组GFR显著下降(P=0.046);与非HFPEF组比较,HFPEF组E/Em值显著升高(P<0.001),Em值显著降低(P=0.002),左心房内径显著增加(P<0.001),LVEF显著降低(P=0.012),BNP值显著升高(P=0.001)。HFPEF组患者GFR与E/Em(r=-0.428,P=0.001),GFR与BNP(r=-0.435,P=0.001),E/Em与BNP(r=0.392,P=0.002)均相关。结论老年HFPEF患者年龄较大,且多合并高血压、糖尿病、冠心病、房颤,往往表现为多种疾病并发。老年HFPEF患者肾小球滤过率显著下降,且与心脏舒张功能指标具有显著的相关关系。

Objective To observe the changes of renal function in elderly patients with heart failure but normal ejection fraction, and explore its clinical significance. Methods A total of 145 cases diagnosed as coronary artery disease from Department of Geriatric Cardiology in The First Affili- ated Hospital of China Medical University were enrolled in the study. All of the cases were divided into HFPEF group （65 cases） and non HFPEF group （ 80 eases）. All patients underwent cardiac ultrasound, BNP and renal function examination, and the glomerular filtration rate （GFR） was cal- culated. Results The average age of patients in HFPEF group was significantly higher than non HFPEF group （P 〈 0.001 ）, and the incidence of hypertension, diabetes, coronary heart disease, atrial fibrillation, or concomitant incidence of two or more kinds of these disease in HFPEF group was significantly higher than non HFPEF group （P1 = 0.046, P2 〈0.001, P3 = 0.002, P4 -- 0.021, P5 〈0.001 ） ; the GFR of two groups of patients were lower than normal level, but the GFR of HFPEF group was significantly lower than non HFPEF group （P = 0.046） ; E / Em was significantly higher （P 〈 0.001 ）, Em was significantly lower （P = 0.002）, left atrial diameter was significantly higher （ P 〈 0.001 ）, LVEF was significantly lower （P = 0.012）, BNP values were significantly higher （P = 0.001 ） in HFPEF group than in the non-HFPEF group ; There were significant linear correlation between GFR and E /Em （r =-0.428, P = 0.001 ）, GFR and the BNP （r =-0.435, P = 0.001 ）, E /Em and BNP （r = 0.392, P = 0.002） in HFPEF group. Conclusion Elderly patients with heart failure but normal ejection fraction were older, and more of them were complicated with hyperten- sion, diabetes, coronary heart disease, atrial fibrillation, or concun^ncy of these diseases. Glomendar fdt^ation rate was significantly decreased in el- derly patients with HFPEF, which has a significant correlation with diastolic function parameters.