浅论风湿性心脏病患者在不同心功能状态下其肾功能指标的变化及意义

摘要

Objective To investigate the changes and clinical significance of renal functional indexes including blood urea nitrogen, serum creatinine and cystatin-C under different cardiac function classes in rheumatic heart disease patients with heart failure. Methods A retrospective study was conducted in 58 rheumatic heart disease patients with heart failure who were admitted in our cardiovascular department during 2012.12 to 2014.12. All patients were divided into class II group(control,n=19),class III group(n=15) and class IV group(n=24) according to NYHA cardiac functional grading. 18 rheumatic heart disease patients with normal cardiac function were selected as the control group.Serum concentration of NT-proBNP, blood urea nitrogen, serum creatinine and cystatin-C were detected respectively and then analyzed. Results Concentration of serum NT-proBNP in rheumatic heart disease patients with heart failure was increased significantly in accordance with NYHA class in each group(P<0.01).Serum BUN concentration of patients in class IV group was significantly higher than in control,class II and class III group respectively (P<0.01) while no statistically significant difference of serum BUN concentration was found in the three group. Compared with the control,cys-C concentration in each group increased significantly(P<0.01),which is obvious in class IV group while no statistically significant difference was found between class II and III group.No statistically significant difference of serum creatinine concentration was found in each group.Positive correlation was found between NT-proBNP and cystatin-C in class IV group,the pearson correlation coefficient is 0.58 (P<0.01). Conclusion Cystatin-C can be used as a relatively sensitive clinical index predicting and evaluating early anterior renal damage of renal function in rheumatic heart disease patients with heart failure especially severe heart failure to some extent.%目的：探讨风湿性心脏病患者在不同心功能状态下其肾功能指标的变化及意义。方法：对2012年12月～2014年12月期间我院心内科收治的76例风湿性心脏病患者的临床资料进行回顾性研究。我院将其中18例心功能正常的风湿性心脏病患者归类为对照组，将其中58例风心病心力衰竭患者按照美国纽约心脏病协会（NYHA）规定的心功能分级标准分为心力衰竭II级组、心力衰竭III级组与心力衰竭IV级组，其中心力衰竭II级组中有19例患者，心力衰竭III级组中有15例患者，心力衰竭IV级组中有24例患者。我院对各组患者进行血清N端脑钠肽前体水平（NT-proBNP）及肾功能指标（包括血尿素氮（BUN）、肌酐（Cr）、胱抑素C（cys-C）水平）检测，然后总结并分析各组患者在不同心功能状态下其肾功能指标的变化及意义。结果：随着患者心力衰竭程度的加重，各组患者血清NT-proBNP的水平均明显高于前一组患者血清NT-proBNP 的水平，差异显著（P<0.05），具有统计学意义。心力衰竭IV 级组患者血清BUN 的水平与血清Cr 水平明显高于对照组、心力衰竭II 级组、心力衰竭III 级组患者血清BUN 的水平与血清Cr 水平，差异显著（P<0.05），具有统计学意义。心力衰竭 II 级组、心力衰竭III 级组、心力衰竭IV 级组患者血清cys-C 的水平均明显高于对照组患者血清cys-C 的水平，差异显著（P<0.05），具有统计学意义。心力衰竭IV 级组患者的血清NT-proBNP 的水平与其血清Cr、cys-C 的水平成正相关，其血清 NT-proBNP 的水平与其血清BUN 的水平无明显相关。心力衰竭II 级组、心力衰竭III 级组患者血清NT-proBNP 的水平与其血清BUN、Cr、cys-C 的水平呈负相关或无明显相关。结论：血清cys-C 水平可以作为预测和评估风心病心力衰竭患者尤其是重度心力衰竭患者早期肾前性肾功能损害程度的敏感指标。