慢性心脏病住院患者2型心肾综合征的发生情况分析

摘要

目的 了解慢性心脏病(Chronic kidney disease,CHD)患者2型心肾综合征(Cardiorenal syndrome,CRS)的发生情况并探讨其相关因素.方法 本研究对自2008年7月至2009年7月于上海交通大学医学院附属仁济医院心脏内科住院的1275名患者的病历资料进行了回顾性调查.由MDRD公式估算肾小球滤过率(estimated glomerular filtration rate,eGFR),并对患者的基础资料包括年龄、性别、慢性病病史、相关实验室指标以及生活方式等进行了收集和分析.结果 1275名CHD住院患者的2型CRS患病率为18.4%(235/1275).2型CRS患者年龄较非CRS人群偏高,且更多存在糖尿病(28.9% 比 21.8%,P＜0.05＝和脑血管事件(9.8% 比 5.7%,P＜0.001＝.单变量分析结果显示血红蛋白( r=-0.148,P＜0.001＝、白蛋白(r= -0.147,P＜0.001＝、C反应蛋白(r=-0.330,P＜0.001＝、纤维蛋白原(r=0.098 P＜0.05＝、乳酸脱氢酶(r=0.127,P =0.042)、B型脑钠素(brain natriuretic peptide,BNP)(r= 0.182,P＜0.001＝、尿酸(r= 0.142,P＜0.001＝以及NYHA分级(r = 0.189,P＜0.001＝与2型CRS发生相关.进一步分析发现 2型CRS的发生与年龄[OR=1.039(1.013-1.065),P= 0.003]、白蛋白[OR=0.912(0.852～0.976),P=0.008]和尿酸[OR=1.005(1.003-1.007),P＜0.001＝水平有着密切联系.结论 本研究结果表明在CHD患者中2型CRS患病率高.某些心肾传统危险因素及患者心功能等情况与2型CRS的发生相关.对于高龄、高尿酸血症及营养状况较差的CHD患者,2型CRS的早期诊断和早期治疗尤为重要.%Objective In this study, we aim to investigate the prevalence of type 2 cardio-renal syndrome (CRS) in chronic heart disease (CHD) patients and to find out the factors relating to type 2 CRS. Methods A retrospective, cross-sectional analysis of 1275 CHD inpatients in the Cardiology Department from July 2008 to July 2009 was conducted. Estimated glomerular filtration rate (GFR) was calculated using the simplified Modification of Diet in Renal Disease (MDRD) equation. Baseline characteristics including age, gender, lifestyle, medical history, physical examination, laboratory variables were collected and analyzed. Results Of the 1275 CHD inpatients, the prevalence of type 2 CRS was 18.4% (235/1275). Patients with type 2 CRS were older than those without CRS. Compared to the patients without CRS, type 2 CRS patients were more likely to have medical histories of diabetes mellitus (28.9% vs. 21.8%, P < 0.05), hyperuricemia (41.3% vs. 26.4%, P < 0.001) and cerebrovascular disease (9.8% vs. 5.7%, P < 0.001). Univariate analysis showed the significant correlation between type 2 CRS and BNP (/=0.182, P < 0.001), Hb (/=-0.148, P < 0.001), Alb (r=-0.147, P < 0.001), CRP (r=-O.33O, P < 0.001), FIB (r= 0.098, P < 0.05), LDH (r= 0.127, P=0.042), UA (r= 0.142, P < 0.001) and NYHA stage (r=0.189, P < 0.001). Moreover, older age (odds ratio [OR] =1.039, 95% confidence interval [CI] =1.013-1.065), lower Alb (OR=0.92, 95% CI=0.852-0.976) and hyperuricemia (O/?=1.005,95% CI =1.003 -1.007) were the risk factors for type 2 CRS. Conclusion This study suggested that the prevalence of type 2 CRS was high in CHD patients. Some traditional risk factors for cardio-renal disease and cardiac function also contributed to type 2 CRS. Early diagnosis and treatment of type 2 CRS are important especially for CHD patients with advanced age, malnutrition and hyperuricemia.