慢性心功能不全患者合并肾功能不全的高危因素分析

摘要

目的 探讨心肾综合征(CRS)的相关危险因素,为防治CRS提供参考依据.方法 采用回顾性对照研究,选取269例慢性心功能不全患者,根据肾小球滤过率估计值(eGFR)分为2组,eGRF<60 mL/(min!1.73 m2)者为病例组(CRS组),eGRF≥60 mL/(min!1.73 m2)者为对照组,收集患者的一般资料及相关临床化验指标和辅助检查指标,采用多因素logistic回归分析慢性心功能不全合并肾功能不全的相关危险因素.结果 慢性心功能不全患者发生CRS的患病率为26.39%.单因素分析结果显示, 2组间年龄、体质量、高血压病史、糖尿病史差异有统计学意义(P<0.05).CRS组尿酸、胱抑素C、血清尿素氮、脑钠肽、糖化血红蛋白、超敏C反应蛋白及左室舒张末内径较对照组明显升高;红细胞计数、血红蛋白、白蛋白及左室射血分数较对照组明显降低,差异有统计学意义(P<0.05).多因素logistic回归分析表明,高龄、低体质量、高血压病史、糖尿病史、低白蛋白血症、高超敏C反应蛋白水平、高尿酸血症、高胱抑素C血症、低射血分数与CRS的发生独立相关.结论 高龄、低体质量、高血压病史、糖尿病史、低白蛋白血症、高超敏C反应蛋白水平、高尿酸血症、高胱抑素C血症、低射血分数是心衰患者发生CRS的高危因素,且独立相关.早期识别及控制这些危险因素对CRS的防治具有重要意义.%Objective To elucidate the related risk factors for the cardiorenal syndrome(CRS),and to provide a reference for the prevention and treatment of CRS. Methods A retrospective study was conducted on 269 patients with chronic heart failure. The subjects were divided into two groups in accordance with estimated glomerular filtration rate(eGFR):patient group(CRS group),eGRF<60 mL/(min ! 1.73 m2)and control group,eGRF≥60 mL/(min!1.73 m2). The patients'general information as well as the related clinical lab indices and accessory examination indi-ces were collected. The risk factors for chronic heart failure and renal insufficiency were analyzed with multivariate logistic regression analysis. Re?sults The prevalence of chronic heart failure patients suffering from CRS was 26.39%. The single factor analysis showed that there were statistically significant differences between the two groups in terms of age,body weight,history of hypertension,and history of diabetes(all P<0.05). Compared to the control group,uric acid,cystatin C,serum urea nitrogen,brain natriuretic peptide,glycosylated hemoglobin,high-sensitivity C-reactive pro-tein,and left ventricular end-diastolic diameter in the CRS group were significantly higher;white blood cell count,hemoglobin,albumin,and left ventricular ejection fraction were significantly lower(all P<0.05). There was no statistically significant difference(P>0.05)between the two groups in regard to white blood cell count,glutamic-pyruvic transaminase,glutamic oxalacetic transaminase,cholesterol,triglycerides,high density lipoprotein,low density lipoprotein,troponin I,serum free triiodothyronine,serum free thyroxine,or thyroid stimulating hormone. Multivariate logis-tic regression analysis showed that older age,low body weight,history of hypertension,history of diabetes,hypoalbuminemia,superb sensitivity C-re-active protein levels,high uric acid,high cystatin C hyperlipidemia,and low ejection fraction were independently associated with the occurrence of CRS. Conclusion Older age,low body weight,history of hypertension,history of diabetes,hypoalbuminemia,high-sensitivity C-reactive protein levels,high uric acid,high cystatin C hyperlipidemia,and low ejection fraction are the high risk factors for CRS in heart failure patients and are inde-pendently associated with the occurrence of CRS. Early identification and control of these risk factors are important for the prevention and treatment of CRS.