慢性心力衰竭患者尿白蛋白与肌酐比值水平变化

摘要

目的：以尿蛋白与肌酐比值（ UACR）为观察指标，比较不同程度的慢性心衰患者UACR的水平，以及与血浆脑利钠肽（ BNP）的相关性。方法选择103例住院患者，按照纽约心功能分级（ New York Heart Association class，NYHA），分为Ⅰ～Ⅳ级，心功能Ⅰ级患者为对照组，共20例，心功能Ⅱ～Ⅳ级的患者为心衰组，共83例，其中心功能Ⅱ级32例，心功能Ⅲ级28例，心功能Ⅳ级23例。入院后留取晨尿，用免疫比浊法检测尿白蛋白，酶法测量尿肌酐，计算UACR。结果心衰组患者UACR水平LnUACR（3．97±1．68）明显高于对照组（1．09±0．53），P＜0．05；UACR水平随着心衰程度的加重而逐渐升高，心功能Ⅳ级组UACR水平LnUACR（4．28±1．00）明显高于心功能Ⅱ级组（3．61±0．26）、Ⅲ级组（4．07±1．02），三组之间比较差异有显著性意义（P均＜0．05）；UACR水平与心功能级别及NT -proBNP 呈正相关（ r ＝0．328， P ＜0．05；r ＝0．375， P ＜0．05）， UACR 水平与 eGFR 呈负相关（r＝-0．236，P＜0．05）。结论慢性心衰患者的UACR水平明显升高，并且随着心衰的加重，呈上升趋势。%Objective Our aim is to evaluate the levels of UACR in patients with established chronic heart failure and the association between albuminuria and deterioration of heart function .Methods A total of 103 patients collected in the second affiliated hospital of Dalian medical university , of which 20 cases with NYHA classⅠ( according to NYHA classification ) as control group, other 83 cases were symptomatic heart failure (32 cases of NYHA classⅡ, 28 cases of NYHA class Ⅲ, 23 cases of NYHA classⅣ) .The baseline clinical data were collected including age , gender , previous history and drug u-sing, etc.All patients provided a first morning spot sample of urine to calculate the UACR .Results The levels of UACR were significantly higher in heart failure patients (LnUACR 3.97 ±1.68) than that of control groups (1.09 ±0.53, P<0.05).The levels of UACR increased with deterioration of cardiac function:NYHA class Ⅳ(LnUACR 4.28 ±1.00) vs. classⅢ(4.07 ±1.02, P<0.05), classⅢ(LnUACR 4.07 ±1.02) vs.(3.61 ±0.26, P<0.05).The levels of UACR had positive correlation with the cardiac function (r=0.328, P<0.05),and the levels of NT-proBNP (r=0.375, P<0.05), the levels of UACR had negative correlation with eGFR (r=-0.236, P<0.05).The levels of UACR and NT-proBNP were significantly decreased after heart failure treatment in the effective group (P<0.05).Conclusion The results suggest that the levels of UACR in patients with chronic heart failure are significantly high and tend to increase with the de -terioration of heart function .