血清总胆红素水平与老年慢性心力衰竭患者早期肾功能损害的相关性研究

Correlation between serum total bilirubin level and early renal impairment in elderly patients with chronic heart failure

目的探讨血清总胆红素(TBIL)水平与老年慢性心力衰竭(CHF)患者早期肾功能损害的相关性研究。方法对2015年5月至2017年12月湖州市中心医院住院的老年CHF患者临床资料进行回顾性分析,按照入院时血清TBIL水平分为高水平TBIL组和低水平TBIL组,采用logistic回归方程分析TBIL与早期肾损害的关系,利用ROC曲线评估TBIL对其的预测价值。结果共有192例患者纳入,与低TBIL组比较,高TBIL组患者收缩压、左心室舒张末期内径(LVEDd)、N末端脑钠肽原(NT-proBNP)、空腹血糖(FPG)、尿微量白蛋白(MAU)水平较高,而左心室射血分数(LVEF)、估算肾小球滤过率(e GFR)较低,两组比较差异均有统计学意义(均P<0.05);高TBIL组早期肾损害发生率高于低TBIL组(60.47%vs 22.82%,χ~2=22.013,P<0.01);肾损害组血清TBIL水平[(23.14±6.81)μmol/L]高于非肾损害组[(18.36±5.10)μmol/L](t=5.559,P<0.01)。多因素log is tic回归方程显示TBIL是老年CHF患者发生早期肾损害的独立危险因素(OR=1.993,95%CI:1.467～3.258,P<0.01);ROC曲线显示TBIL预测早期肾损害的AUC为0.829,灵敏度和特异度为85.20%、70.94%。结论老年CHF患者血清TBIL水平增高与肾功能恶化密切相关。

Objective To investigate the correlation between serum total bilirubin(TBIL)level and early renal damage in elderly patients with chronic heart failure(CHF).Methods Clinical data were analyzed retrospectively in inpatients with CHF from May 2015 to December 2017.They were divided into high TBIL group and low TBIL group according to serum TBIL at admission.Logistic regression was performed to analyze the relation between TBIL and early renal damage.ROC curve was used to evaluate the predictive value of TBIL.Results A total of 192 cases were enrolled.Compared with low TBIL group,systolic blood pressure,left ventricular end-diastolic diameter,N terminal brain natriuretic peptide(NT-proBNP),fasting plasma glucose,urinary microalbuminuria were significantly higher,and left ventricular ejection fraction and estimated glomerular filtration rate were significantly lower in high TBIL group(all P<0.05).The incidence of early renal damage in high TBIL group was significantly higher than in low TBIL group(60.47%vs 22.82%,χ^2=22.013,P<0.01).Serum TBIL level[(23.14±6.81)μmol/L]was significantly higher in patients with renal impairment than without renal impairment[(18.36±5.10)μmol/L](t=5.559,P<0.01).Logistic regression equation showed that TBIL was an independent risk factor for early renal damage in elderly patients with CHF(OR=1.993,95%CI:1.467~3.258,P<0.01).ROC curve showed that the AUC predicted by TBIL for early renal damage was 0.829,and the sensitivity and specificity were 85.20%and 70.94%,respectively.Conclusion Serum TBIL increase in elderly patients with CHF is closely related to the deterioration of renal function.