血清肌酐与前白蛋白比值在慢性心力衰竭合并肾功能衰竭患者中的应用价值

Application of serum creatinine to prealbumin ratio in chronic heart failure patients with renal failure

目的探讨血清肌酐与前白蛋白比值(Scr/PA)在心力衰竭合并肾衰患者的诊断及预后方面的应用价值。方法本研究为病例对照研究。回顾性分析2020年1月5日至2023年4月23日在大连市中心医院收治的慢性心力衰竭及心力衰竭合并肾衰患者的一般资料及实验室检查指标,并计算Scr/PA。比较两组患者一般资料及实验室检查指标,根据数据类型,分别采用t检验、Wilcoxon秩和检验、χ^(2)检验进行组间比较。经单因素及多因素logistic回归分析心力衰竭合并肾衰的危险因素。采用Spearman相关性分析Scr/PA与N-末端B型钠尿肽前体(NT-proBNP)和血红蛋白(HGB)的相关性。通过ROC曲线判断Scr/PA与NT-proBNP对心力衰竭合并肾衰的预测价值。结果与心力衰竭组相比较,心力衰竭合并肾衰组甘油三酯[1.25(0.94,1.81)mmol/L比1.07(0.76,1.46)mmol/L,Z=-2.159,P=0.031]、D-二聚体[2.30(1.53,4.67)mg/L比1.63(0.64,2.96)mg/L,Z=-2.339,P=0.02]、NT-proBNP[18500(9575,30000)pg/ml比4865(1600,9800)pg/ml,Z=-5.637,P<0.001]、Scr/PA[0.233(0.188,0.351)mg/mg比0.064(0.044,0.103)mg/mg,Z=-8.197,P<0.001]更高,而白蛋白(33.9±5.2 g/L比36.3±4.3 g/L,t=-2.173,P=0.008)、估算的肾小球滤过率[12.86(7.88,17.40)ml/(1 min×1.73 m^(2))比65.82(48.66,86.32)ml/(1 min×1.73 m^(2)),Z=-9.794,P<0.001]、HGB[(91±24)g/L比(123±23)g/L,t=-7.489,P<0.001]更低。经单因素logistic回归分析,白蛋白(OR=0.900,95%CI 0.830~0.975,P=0.010)、HGB(OR=0.948,95%CI 0.930~0.966,P<0.001)、Scr/PA(OR=1.639,95%CI 1.346~1.957,P<0.001)与心力衰竭合并肾衰相关;经多因素logistic回归分析,只有Scr/PA是心力衰竭合并肾衰的独立危险因素。Scr/PA与NT-proBNP和HGB的相关系数分别为r=0.578和r=-0.559(P均<0.001)。Scr/PA与NT-proBNP对心力衰竭合并肾衰的预测AUC曲线下面积分别为0.927(95%CI 0.881~0.973,P<0.001),0.797(95%CI 0.717~0.877,P<0.001)。结论Scr/PA是心力衰竭合并肾衰的独立危险因素,其与NT-proBNP和HGB相关性较好。Scr/PA对心力衰竭合并肾衰的预测价值优于NT-proBNP。

Objective To investigate the application of serum creatinine to prealbumin ratio(Scr/PA)in the diagnosis of patients with heart failure complicated with renal failure.Methods This was a case-control study.Patients with chronic heart failure and heart failure complicated with renal failure admitted to Dalian Central Hospital from January 5,2020 to April 23,2023 were retrospectively analyzed,and Scr/PA was calculated.The general data and laboratory examination indexes of the two groups were compared.According to the data type,t test,Wilcoxon rank sum test andχ^(2) test were used for comparison between the two groups.The risk factors of heart failure complicated with renal failure were analyzed by univariate and multivariate logistic regression analysis,and Spearman correlation analysis was used to analyze the correlation between Scr/PA and N-terminal pro-B-type natriuretic peptide(NT-proBNP)and hemoglobin(HGB).ROC curve was used to determine the predictive value of Scr/PA and NT-proBNP for heart failure complicated with renal failure.Results Compared with the heart failure group,Triglyceride[1.25(0.94,1.81)mmol/L vs.1.07(0.76,1.46)mmol/L,Z=-2.159,P=0.031],D-dimer[2.30(1.53,4.67)mg/L vs.1.63(0.64,2.96)mg/L,Z=-2.339,P=0.02],NT-proBNP[18500(9575,30000)pg/ml vs.4865(1600,9800)pg/ml,Z=-5.637,P<0.001],Scr/PA[0.233(0.188,0.351)mg/mg vs 0.064(0.044,0.103)mg/mg,Z=-8.197,P<0.001]were higher in heart failure complicated with renal failure group.While albumin[(33.9±5.2)g/L vs.(36.3±4.3)g/L,t=-2.173,P=0.008],estimated glomerular filtration rate[12.86(7.88,17.40)ml/(1 min×1.73 m^(2))vs.65.82(48.66,86.32)ml/(1 min×1.73 m^(2)),Z=-9.794,P<0.001],and HGB[(91±24)g/L vs.(123±23)g/L,t=-7.489,P<0.001]were lower.Univariate logistic regression analysis showed that albumin(OR=0.900,95%CI 0.830-0.975,P=0.010),HGB(OR=0.948,95%CI 0.930-0.966,P<0.001),Scr/PA(OR=1.639,95%CI 1.346-1.957,P<0.001)were associated with heart failure complicated with renal failure.Multivariate logistic regression analysis showed that only Scr/PA was an independent risk factor for heart failure complicated with renal failure.The correlation coefficients of Scr/PA with NT-proBNP and HGB were r=0.578 and r=-0.559,respectively(all P<0.001).The area under the AUC curve of Scr/PA and NT-proBNP for predicting heart failure complicated with renal failure was 0.927(95%CI:0.881-0.973,P<0.001)and 0.797(95%CI:0.717-0.877,P<0.001),respectively.Conclusions Scr/PA is an independent risk factor for heart failure complicated with renal failure,and it has a good correlation with NT-proBNP and HGB.Scr/PA is superior to NT-proBNP in predicting heart failure complicated with renal failure.