肾功能与老年急性失代偿射血分数保留心力衰竭预后的关系

Study on relationship between renal function and prognosis of ederly patients with acute decompensated heart failure and preserved ejection fraction

目的明确在老年急性失代偿射血分数保留心力衰竭(HFp EF)患者中,不同肾功能分期与1年内心衰预后的关系。方法回顾性入选2013年6月至2015年6月在首都医科大学附属北京友谊医院医疗保健中心心血管病房住院的急性失代偿射血分数保留心力衰竭老年患者(年龄≥65岁),记录基本情况、合并疾病、用药情况,检测生化指标、超声心动图指标,根据MDRD-EPI公式计算估测肾小球滤过率(eGFR),入选eGFR≥30 ml/(min·1.73 m^2)的患者145例并根据K-DOQI指南分期分为3组。1组eGFR≥90 ml/(min·1.73 m^2),2组eGFR 60~90 ml/(min·1.73m^2),3组eGFR 30~60 ml/(min·1.73 m^2)。比较各组患者的临床、实验室及超声心动图参数,比较各组患者的心衰死亡、心衰再住院及全因死亡等终点事件的差异,采用Kaplan-Merier曲线分析比较肾功能分期与心衰的关系。结果 3组患者纽约心脏病协会心功能分级为IV级的患者比率显著高于1组和2组,各组之间的血清肌酐、尿素氮、尿酸及N末端脑钠肽前体(NT-pro BNP)均有显著差异,1组最低,3组最高,血红蛋白水平的组间差异相反;3组患者心衰再住院及所有终点事件的发生率显著高于1组和2组;Kaplan-Meier曲线显示3组患者的心衰再住院及所有事件发生率明显高于1组和2组,差异有显著性(log rank P=0.001及P=0.022)。结论以eGFR评价的肾功能与老年急性失代偿HFpEF患者1年内心衰再住院等预后有关。

Objective To explore the relationship between renal function and prognosis of 1 year adverse outcome in elderly patients with acute decompensated heart failure and preserved ejection fraction(HFpEF).Methods A total of 145 consecutive patients(≥65 years old)with acute decompensated heart failure and preserved ejection fraction admitted in this department during June 2013 to June 2015 were enrolled in this retrospective study.Basic characteristics,laboratory parameters and echocardiographic parameters were examined and recorded,eGFR was calculated by using MDRD-EPI formula and patients with eGFR<30 ml/(min·1.73 m 2)were excluded.All these patients were divided into three groups according to eGFR,patients with eGFR≥90 ml/(min·1.73 m 2)were listed in group 1,patients in group 2 with eGFR 60~90 ml/(min·1.73 m 2),and patients in group 3 with eGFR 30~60 ml/(min·1.73 m 2).Baseline characteristics,laborotary and echocardiographic parameters,as well as adverse outcomes of death caused by heart failure,heart failure re-admission and all-causes for death in 1-year follow up period were compared among these three groups,association of 1 year adverse outcomes and stages of renal function were analyzed by Kaplan-Meier curve.Results In comparison with group 1 and group 2,patients in group3 had a higher proportion of NYHA IV and higher serum levels of creatinine,urea nitrogen,uric acid and NT-proBNP with significant difference,all these above-mentioned parameters were highest in group 3 and lowest in group 1,to the contrary,the hemoglobin levels were highest in group 1 and lowest in group 3.Readmission for heart failure and all event prevalence in group 3 were the highest,Kaplan-Meier curve showed a significant difference between group 3 and group 1 or group 2(log rank P=0.001 and P=0.022,respectively).Conclusion Renal function estimated by eGFR had correlation with adverse outcomes such as re-admission for heart failure in elderly patients with acute decompensated HFpEF.