慢性心力衰竭患者8年生存的肾功能相关指标影响因素分析

Analysis for Renal Function Related Influencing Factors on 8-year Survival in Chronic Heart Failure Patients

目的:采用血清肾功能相关参数及临床基线分析预测慢性心力衰竭(心衰)患者8年生存风险。方法:入选我院2006-07至2009-11期间在我院因慢性心衰急性发作入院,并随访至2014-06-30(以患者随访期间内死亡为该研究的终点)的患者293例。均接受常规肾功能、电解质检验,检验参数包括尿素氮、肌酐、尿酸、血钠、血钾、血氯、血钙、阴离子间隙和血磷指标,应用改良MDRD公式计算肾小球滤过率,并对患者行血压及彩色超声心动图检查,获取患者临床基线参数(包括左心室舒张末期内径、左心室射血分数、血压及心率),并对以上15项参数结果分组[按照随访结果将患者分为存活组(107例)和死亡组(186例)],对慢性心衰患者进行8年内生存分析。结果:与存活组比较,死亡组患者的左心室舒张末期内径、尿素氮、肌酐及尿酸升高,而左心室射血分数、心率、肾小球滤过率、血钠及血钙降低,差异均有统计学意义(P均<0.05)。单因素分析结果显示,左心室舒张末期内径、左心室射血分数、肾小球滤过率、尿素氮、肌酐、尿酸、血钠、血钙、血磷对慢性心衰患者8年内生存分析风险有较好的预测价值(P均<0.05)。多因素分析结果显示:左心室舒张末期内径、肾小球滤过率及血钠对慢性心衰患者8年内生存分析风险预测价值最大(P均<0.001),其次为血钙(P均<0.01)。结论:左心室舒张末期内径、左心室射血分数、肾小球滤过率、尿素氮、肌酐、尿酸、血钠、血钙为慢性心衰患者8年内生存分析的特异指标,Cox分析显示左心室舒张末期内径、肾小球滤过率、血钠、血钙为预测慢性心衰患者8年内生存分析的独立危险因素。

Objective： To assess blood levels of renal function related influencing factors with baseline clinical parameters for predicting the risk of 8-year survival in patients with chronic heart failure （CHF）. Methods： A total of 293 CHF patients admitted in our hospital from 2006-07 to 2009-11 were enrolled. The patients were followed-up until 2014-6-30, the end point was death. According to followed-up results, they were divided into 2 groups： Survival group,n=107 and Death group,n=186. All patients received routine renal function and electrolytes examination including blood levels of urea nitrogen, creatinine, uric acid, sodium, potassium, chloride, calcium, anion gap and phosphorus; GFR was calculated by MDRD formula. Baseline clinical parameters as left ventricular end diastolic diameter （LVEDD）, left ventricular ejection fraction （LVEF） were measured by echocardiography; blood pressure （BP） and heart rate （HR） were recorded. The risk factors for 8-year survival in CHF patients were analyzed. Results： Compared with Survival group, Death group had increased LVEDD, urea nitrogen, creatinine and uric acid, while decreased LVEF, HR, GFR, blood sodium and calcium, allP〈0.05. Univariate analysis indicated that LVEDD, LVEF, GFR, urea nitrogen, creatinine, uric acid, blood sodium, calcium and phosphorus had the better predictive value for the risk of 8-year survival in CHF patients, allP〈0.05. Multivariate analysis presented that LVEDD, GFR and blood sodium had the highest predictive value for the risk of 8-year survival, allP〈0.001; the next one was blood calcium,P〈0.01. Conclusion： LVEDD, GFR, blood sodium and calcium were the independent predictors for the risk of 8-year survival in CHF patients.