血红蛋白水平对住院心衰患者肾功能恶化的影响

Association of hemoglobin and risk of worsening of renal function during heart failure hospitalization

目的探讨入院血红蛋白水平与住院心力衰竭(心衰)患者肾功能恶化的关系。方法选取2013年11月至2015年5月于中山大学附属第一医院因心衰住院的患者为研究对象,按照血红蛋白水平将其分为低(<144 g/L)、中(144~136 g/L)、高(≥137 g/L)血红蛋白三分位组。采用单因素和多因素Logistic回归分析,以血红蛋白分组为多分类自变量,肾功能恶化为二分类因变量,探讨二者之间的关系。另外将血红蛋白分组改为血红蛋白水平这一连续型变量代入Logistic回归模型进一步明确上述关系。结果共有321例患者入选本研究。校正混杂因素后,与低血红蛋白三分位组患者相比,中、高血红蛋白三分位组患者发生肾功能恶化的风险显著降低(OR=0.46,95%CI:0.25~0.86,P=0.016;OR=0.31,95%CI:0.16~0.63,P=0.001)。进一步分析发现,中、高血红蛋白三分位组患者发生持续性肾功能恶化(persistent worsening of renal function,pWRF)的风险显著降低(OR=0.48,95%CI:0.23~0.97,P=0.040;OR=0.37,95%CI:0.17~0.82,P=0.026),但发生一过性肾功能恶化(transient worsening of renal function,tWRF)的风险并无显著变化(OR=0.74,95%CI:0.32~1.73,P=0.490;OR=0.43,95%CI:0.16~1.17,P=0.099)。将血红蛋白水平作为连续变量纳入Logistic回归模型,所得结果与分组分析相似,血红蛋白水平每上升5 g/L,发生肾功能恶化的风险下降6%(OR=0.94,95%CI:0.88~0.99,P=0.022),发生pWRF的风险下降7%(OR=0.93,95%CI:0.88~0.99,P=0.026),而发生tWRF的风险无显著改变(OR=0.98,95%CI:0.91~1.05,P=0.552)。结论因心衰住院的患者血红蛋白水平与肾功能恶化相关。在评估心衰患者肾功能恶化的发生风险以及制订治疗方案时,应考虑血红蛋白水平。

Objective To evaluate the association of hemoglobin and risk of worsening of renal function during heart failure hospitalization. Method Patients hospitalized for heart failure in the First Affiliated Hospital, Sun Yat-sen University from November, 2013 to May 2015 were included in the study. Included patients were categorized according to the hemoglobin tertiles（ 144 g/L, 144 ~ 136 g/L, and ≥ 137 g/L）. Univariate and multivariate Logistic regression models were used to evaluate the association of hemoglobin group and worsening of renal function. To further confirm the association, hemoglobin was also included in the models as a continuous variable. Result There were 321 patients included in the study. After adjusting for potential confounders, compared with low hemoglobin tertile group, intermediate and high hemoglobin tertiles were associated with significantly lower risk of worsening of renal function（OR = 0.46, 95%CI： 0.25 ~ 0.86, P = 0.016; OR = 0.31, 95%CI： 0.16 ~ 0.63, P = 0.001）, which was mostly driven by reduction in persistent worsening of renal function（p WRF）（OR = 0.48, 95%CI： 0.23 ~ 0.97, P = 0.040; OR = 0.37, 95%CI： 0.17 ~ 0.82, P = 0.026）, instead of transient worsening of renal function（t WRF）（OR = 0.74, 95%CI： 0.32 ~ 1.73, P = 0.490; OR = 0.43, 95%CI： 0.16 ~ 1.17, P = 0.099）. Including hemoglobin as a continuous variable in the models yielded similar results. A5 g/L increase in hemoglobin was associated with a 6% reduction in risk of worsening of renal function（OR = 0.94, 95%CI： 0.88 ~ 0.99, P = 0.022）, a 7% reduction in risk of p WRF（OR = 0.93,95%CI： 0.88 ~ 0.99, P = 0.026）, but no significant change in risk of t WRF（OR = 0.98, 95%CI： 0.91 ~ 1.05, P = 0.552）. Conclusion A low hemoglobin level is associated with an increased the risk of worsening of renal function among patients hospitalized for heart failure. Hemoglobin should be taken into account when evaluating risk of worsening of renal function and making treatment decision for patients with heart failure.