老年慢性心力衰竭患者肾功能不全发生率及临床特征分析

摘要

Objective To study the incidence rate of renal dysfunction and clinical feature in elderly patients with chronic heart failure.Methods 436 elderly patients with chronic heart failure from October 2005 to October 2010 who were first time admitted to General Hospital of People's Liberation Army were selected and divided into normal renal function group (n =176),mild renal function descend group (n =141),moderate or severe renal function descend group (n =119) according to eGFR results.MDRD was used to calculate the eGFR.Incidence of renal dysfunction was calculated and clinical feature was analyzed and compared among 3 groups.Results ①The incidence rate of mild renal function descend was 32.3％ (141/436),the incidence rate of moderate or severe renal function descend was 27.3％ (119/436).②The ratio of coronary heart disease,hypertensive heart disease,cardiac function Ⅳ grade in mild renal function descend group [56.0％ (79/141),17.0％ (24/141),34.8％ (49/141)] and moderate or severe renal function descend group [72.3％ (86/119),17.6％ (21/119),42.0％ (50/119)] were all higher than those in normal renal function group [51.1％ (90/176),15.3％ (27/176),11.9％ (21/176)],the differences were statistically significant (P ＜ 0.05 or P ＜0.01).③The level of eGFR,left ventricular ejection fraction,in mild renal function descend group [68 (62,89) mL/(min 1.73m2),47.4 (37.8,54.4)％] and moderate or severe renal function descend group [41 (17,57) mL/(min· 1.73m2),46.2 (31.2,55.1)％] were all lower than those in normal renal function group [103(91,114) mL/(min· 1.73m2),49.9(41.1,56.4)％],brain natriuretic peptide,urea nitrogen,creatinine in mild renal function descend group [778 (315,5437) ng/L,6.94 (5.4,9.6) mmol/L,98.1 (76.5,123.2) μmol/L] and moderate or severe renal function descend group [969 (521,9983) ng/L,12.1 (8.9,26.5) mmol/L,163.6 (117.9,253.8) μmol/L] were all higher than those in mild renal function descend group [541 (201,3158) ng/L,5.5 (4.1,7.6) mmol/L,78.2 (53.4,89.2) μmol/L],the differences were statistically significant (P ＜ 0.05 or P ＜ 0.01).Conclusion Elderly patients with chronic heart failure has high incidence rate of renal dysfunction,it is right to take targeted treatment according to their clinical feature.%目的 探讨老年慢性心力衰竭患者并发肾功能不全的发生率,分析其临床特征.方法 选取解放军总医院2005年10月～2010年10月因慢性心力衰竭首次住院的老年患者436例,根据肾小球滤过率(eGFR)结果分为肾功能正常组(n=176)、肾功能轻度下降组(n=141)、肾功能中、重度下降组(n=119).采用改良后简化肾脏病膳食改良试验(MDRD)公式估算eGFR.统计肾功能不全发生率并分析比较三组的临床特征.结果 ①肾功能轻度下降发生率为32.3％(141/436),肾功能中、重度下降发生率为27.3％(119/436).②肾功能中、重度下降组及肾功能轻度下降组冠心病[56.0％ (79/141)、72.3％(86/119)]、高血压性心脏病[17.0％ (24/141)、17.6％(21/119)]、心功能Ⅳ级[34.8％(49/141)、42.0％(50/119)]比例高于肾功能正常组[51.1％(90/176)、15.3％(27/176)、11.9％(21/176)],差异有统计学意义(P＜ 0.05或P＜ 0.01).③肾功能中、重度下降组及肾功能轻度下降组eGFR[68(62,89)、41(17,57)mL/(min· 1.73m2)]、左室射血分数[47.4(37.8,54.4)％、46.2 (31.2,55.1)％]低于肾功能正常组[103(91,114)mL/(min· 1.73m2)、49.9(41.1,56.4)％],肾功能中、重度下降组及肾功能轻度下降组脑利钠肽[778(315,5437)、969(521,9983)ng/L]、尿素氮[6.94 (5.4,9.6)、12.1 (8.9,26.5) mmol/L]、肌酐[98.1 (76.5,123.2)、163.6(117.9,253.8)μmol/L]水平高于肾功能正常组[541(201,3158)ng/L、5.5(4.1,7.6)mmol/L、78.2(53.4,89.2) μmol/L],差异均有统计学意义(P＜ 0.05或P＜ 0.01).结论 老年慢性心力衰竭患者肾功能不全发生率较高,应根据其临床特征采取有针对性治疗措施.