急性心力衰竭患者院内收缩压变化值与肾功能恶化的相关性分析

Analysis of correlation between the changes value of systolic blood pressure in hospital and worsening renal function in patients with acute heart failure

目的分析急性心力衰竭(AHF)患者院内收缩压变化值(ΔSBP)与肾功能恶化(WRF)的相关性。方法回顾性分析2018年1月至2021年3月于我院住院治疗的118例AHF患者的临床资料。记录患者的临床特征及生化指标,比较发生WRF和未发生WRF患者的一般资料,采用多因素Logistic回归分析AHF患者各指标与WRF发生的相关性。结果发生WRF者共40例,未发生WRF者共78例,WRF组与无WRF组的SBP、ΔSBP、Hb、ALB、Scr、GFR、BUN、血清K+、LVEF、糖尿病史、高血压史及入院前螺内酯服用史患者数量比较,差异具有统计学意义(P<0.05)。将患者ΔSBP水平分为高ΔSBP水平(ΔSBP<-16 mmHg),发生WRF者19例(47.50%);中等ΔSBP水平(ΔSBP-16~-4 mmHg),发生WRF者14例(35.90%),低ΔSBP水平(ΔSBP>-4 mmHg),发生WRF者7例(17.95%),不同ΔSBP水平患者的WRF发生率比较,差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,ΔSBP每下降10 mmHg,WRF的发生风险便较前显著增加(OR=1.058,95%CI:1.026~1.091,P<0.001),高ΔSBP水平的WRF发生风险是低ΔSBP水平的1.556倍(95%CI:1.301~1.861,P<0.001),此外,高血压史、糖尿病史、Scr是发生WRF风险的危险因素,ALB和LVEF是发生WRF风险的保护因素(P<0.05)。结论ΔSBP、高血压史、糖尿病史、Scr、ALB和LVEF对AHF患者WRF的发生有一定的评估价值。

Objective To analyze the correlation between the changes of systolic blood pressure in hospital(ΔSBP)and worsening renal function(WRF)in patients with acute heart failure(AHF).Methods The clinical data of 118 patients with AHF hospitalized in our hospital from January 2018 to March 2021 were analyzed retrospectively.The clinical characteristics and biochemical indexes of patients were recorded,and the general data of patients with or without WRF were compared.The correlation between the various indexes of AHF patients and WRF was analyzed by multivariate Logistic regression.Results There were 40 cases with WRF and 78 cases without WRF.There were statistically significant differences in SBP,ΔSBP,Hb,ALB,Scr,GFR,BUN,serum K+,LVEF in numbers of patients with diabetes history,hypertension history and history of taking spironolactone before admission between the WRF group and in non-WRF group(P<0.05).TheΔSBP level of patients was divided into highΔSBP level(ΔSBP<-16 mmHg)including 19 cases(47.50%)with WRF;mediumΔSBP level(ΔSBP-16 mmHg--4 mmHg)including 14 cases(35.90%)with WRF;lowΔSBP level(ΔSBP>-4 mmHg)including 7 cases(17.95%)with WRF,and the incidence of WRF in patients with differentΔSBP levels was statistically significant(P<0.05).The multivarjate Logistic regression analysis result showed that for every 10 mmHg decreased inΔSBP,the risk of WRF increased significantly than before(OR=1.058,95%CI:1.026-1.091,P<0.001),and the risk of WRF with highΔSBP level was 1.556 times of that of lowΔSBP level(95%CI:1.301-1.861,P<0.001).In addition,hypertension and diabetes history and Scr were risk factors for the risk of WRF,while ALB and LVEF were protective factors for the risk of WRF(P<0.05).Conclusion Changes in admission SBP,hypertension and diabetes history,Scr,ALB and LVEF have certain value in evaluating WRF in patients with AHF.