蛋白尿对老年慢性心力衰竭患者心功能影响的研究

摘要

Objective To determine the impact of albuminuria to cardiac function in elderly chronic heart failure (CHF) patients in China.Methods Totally 457 CHF patients were enrolled in this study.The patients were divided into Negative Group and Positive Group according to urine routine test or albuminuria test for 24 hours (≥30 mg/24h).Among these people,214 patients with albuminuria test for 24 hours were divided into three subgroup.Urine microalbuminuria (UMA),urine microalbuminuria / creatinine ratio (UACR),NT-proBNP,hypersensitive C reactive protein (hsCRP),serum creatinine and echocardiography were determined in all subjects.Comparing to patients without albummuria,patients with albuminuria had higher level of NYHA classification and higher rehospitalization rate.Patients with albuminuria had higher UMA,UACR,serum creatinine (sCr) (P＜0.001) and also higher NT-proBNP and hsCRP (P＜0.05).The cardiac structure and cardiac function were improved with albuminuria decreased (P＜0.05) at average one year follow-up.Conclusion The incidence of albuminuria is high among elderly CHF patients and albuminuria is one of the independent predictors of cardiac rehospitalization.Cardiac function and progress of CHF can be improved by albuminuria decreased.%目的 探讨蛋白尿对中国老年慢性心力衰竭(CHF)患者心功能的影响.方法 人组老年CHF患者457例,根据尿常规定性结果或24h尿蛋白定量结果(≥30 mg/24h)分为尿蛋白阳性组和阴性组,同时在所有患者中将214名患者根据24h尿蛋白定量结果进行亚组分析,测定尿微量白蛋白(UMA)、尿白蛋白比肌酐比率(UACR)、N-氨基酸末端脑利钠肽前体(NT-proBNP)、高敏C反应蛋白(hsCRP)、血肌酐(sCr)和二维超声心动图.结果 本研究中伴有蛋白尿的患者共278例(60.83％).相比阴性组患者,阳性组患者纽约心脏病学会(NYHA)心功能分级更差(P＜0.05),且随着蛋白尿的增加而加重(P＜0.05).蛋白尿阳性组患者具有较高的HF、心源性再住院率及住院天数(P均＜0.05),亚组分析提示再住院发生率和住院天数随着蛋白尿水平增加而增加.阳性组患者的UMA、UACR、血肌酐(sCr)均增高(P均＜0.001),蛋白尿对NT-proBNP、hsCRP也存在影响(P＜0.05).平均随访1年后,伴随阳性组患者尿蛋白水平下降,部分心脏结构指标和心功能指标均有所改善(P＜0.05).结论 蛋白尿在老年CHF患者中的发生率较高,蛋白尿水平较高者心功能较差,是心源性再住院的独立预测因子,蛋白尿的降低能明显改善CHF的进展及预后.