Ⅰ型心肾综合征危险因素分析

Risk factor analysis of type I cardiorenal syndrome

目的了解Ⅰ型心肾综合征的发病情况,分析其危险因素,评估相关化验指标在评价急性肾损伤(AKI)程度中的价值。方法收集中国医科大学附属第一医院2009—2015年急性心功能不全患者的资料,比较发生AKI组(AKI组)和未发生AKI组(非AKI组)平均住院日和院内病死率。通过Logistic回归方程筛选发生Ⅰ型心肾综合征的独立危险因素。分析发生Ⅰ型心肾综合征患者的年龄、住院时间、美国纽约心脏病学会(NYHA)心功能、少尿、射血分数(EF)、肌钙蛋白(TNI)、超敏C反应蛋白(hs-CRP)、脑钠肽(BNP)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、D二聚体(D-D)、纤维蛋白原(Fg)、Tp、白蛋白(ALB)、肌酐(Cr)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、血红蛋白(Hb)和急性肾损伤程度是否相关。结果 481例急性心功能不全患者AKI发生率为37.84%。AKI患者住院病死率是非AKI患者的3.83倍(χ2=14.07,P<0.01)。AKI组平均住院日较非AKI组明显增加(U=22390,P<0.01)。年龄、既往肾病史、高血压、少尿、低HDL-C、Fg升高、贫血是Ⅰ型心肾综合征的独立危险因素。回归方程为:logit P=-6.28+0.03×年龄+1.56×既往肾病史+0.18×高血压+1.27×少尿+0.54×低HDL-C+0.57×Fg升高+0.69×贫血。随NYHA心功能分级、少尿程度、BNP、D-D、肌酐的增加,ALB、Hb减少,肾功能损伤程度逐渐加重。结论Ⅰ型心肾综合征是急性心功能不全的常见并发症,增加患者住院时间及院内病死率,临床上应减少相关危险因素的暴露从而减少Ⅰ型心肾综合征的发生。

Objective To learn about the incidence of type I cardiorenal syndrome analyze the risk factor and assess the relationship between clinical index and degree of acute kidney injury （AKI）. Methods ＂the data were collected from 2009 to 2015 in patients with acute heart failure. ＂ihe average hospitalization days and hospital mortality were compared between AKI group and non-AKI group. The independent risk factors of type I cardiorenal syndrome were screened by logistic regression analysis. The relevances between age, hospitalization time, New York Heart Association （NYHA） classification of cardiac function, oliguria, EF, TNI, hs-CRP, BNP, CK- MB, LDH, D-D, Fg, Tp, ALB, Cr, TG, TC, LDL-c, HDL-c, HB, and the degree of kidney injury were analyzed by correlation analysis. Results In a total of 481 patients, the incidence of AKI was 37.84%. Hospitalized mortality rate AKI group was 3.83 times that of non-AKI group（χ2=14.07, P〈0.01）. The average hospitalization days in AKI group was significantly more than that in non-AKI group（U=22390, P〈0.01）. The age, history of previous nephropath）5 hypertension, oliguria, ]ow high density lipoprotein cholesterol, fibrinogen and elevated, anemia were independent risk factor of type I cardiorenal syndrome. ＂lhe equation of regression is logitP= -6.28＋0.03×age＋1.56× history of previous nephropathy＋0.18× hypertension＋1.27× oliguria,＋0.54× low high density lipoprotein cholesterol＋0.57× fibrinogen elevated＋0.69× anemia. With the increase of NYHA classification of cardiac fimction, oliguria, BNP, D-D and Cr, ALB and Fib decreased, and the level of kidney injury increased. Conclusion Type I cardiorenal syndrome is the common complication of the acute heart failure, which increases the hospitalization days and hospital mortality. We should reduce the incidence of type I cardiorenal syndrome by controUing the relevant risk factors.