临床心血管病杂志
臨床心血管病雜誌
림상심혈관병잡지
JOURNAL OF CLINICAL CARDIOLOGY
2010年
2期
104-108
,共5页
李静%李新立%顾凯%张海锋%徐芳%周艳丽%周蕾%徐东杰%叶行舟%智宏%曹克将
李靜%李新立%顧凱%張海鋒%徐芳%週豔麗%週蕾%徐東傑%葉行舟%智宏%曹剋將
리정%리신립%고개%장해봉%서방%주염려%주뢰%서동걸%협행주%지굉%조극장
心肌病%扩张型%心力衰竭%肾脏%心肾综合征
心肌病%擴張型%心力衰竭%腎髒%心腎綜閤徵
심기병%확장형%심력쇠갈%신장%심신종합정
cardiomyopathy,dilated%heart failure%kidney%cardiorenal syndrome
目的:探讨扩张型心肌病心力衰竭(心衰)患者临床症状、心功能与肾功能的相互关系及其机制.方法:将入选的101例受试者分为心衰组(61例)和对照组(40例),予基本问卷调查、体检、生化及超声心动图等检查.结果:①心衰组心率、血肌酐(SCr)、尿素氮(BUN)、左室舒张末期内径(LVEDD)、左房内径(LAD)及血尿酸(UA)均高于对照组,左室射血分数(LVEF)和肾小球滤过率(eGFR)低于正常对照组(P<0.05).②心衰组合并肾功能异常者的比例较对照组高(P<0.05);心衰组心功能Ⅳ级者较Ⅱ级、Ⅲ级者更易合并肾功能异常(P<0.05, P<0.01).③Pearson相关分析:心衰组UA与SCr、BUN、LVEDD、LAD,BUN与SCr、LVEDD、LAD,SCr与LVEDD、LAD呈正相关(P<0.05);而BUN与舒张压、LVEF,eGFR与年龄、SCr、BUN、LAD呈负相关(P<0.05);偏相关分析:分别调整心衰组年龄、性别等因素后,UA与LVEDD(r=0.454 2,P=0.004),LAD(r=0.460 0,P=0.004),BUN与LVEF(r=-0.364 4,P=0.023)及SCr与LAD(r=0.429 3,P=0.001)仍相关.④心衰组多元逐步回归分析显示:随着 LAD、LVEDD的增加,UA升高;LVEF的下降伴有BUN升高;而LAD的增加可伴有SCr升高.⑤ROC曲线显示SCr及eGFR对出现中重度临床心衰症状的诊断准确性分别为0.712和0.756,且当患者SCr＞84.05 μmol/L或eGFR＜84.845 ml·min~(-1)·1.73 m~(-2)时,就有可能伴有较重的临床心衰症状.结论:扩张型心肌病心衰患者较正常人更易合并有肾功能异常,并且随着心脏的扩大及心功能下降伴有肾功能损害进行性加重;SCr及eGFR分别可作为评价心衰患者疾病加重的临床指标之一.
目的:探討擴張型心肌病心力衰竭(心衰)患者臨床癥狀、心功能與腎功能的相互關繫及其機製.方法:將入選的101例受試者分為心衰組(61例)和對照組(40例),予基本問捲調查、體檢、生化及超聲心動圖等檢查.結果:①心衰組心率、血肌酐(SCr)、尿素氮(BUN)、左室舒張末期內徑(LVEDD)、左房內徑(LAD)及血尿痠(UA)均高于對照組,左室射血分數(LVEF)和腎小毬濾過率(eGFR)低于正常對照組(P<0.05).②心衰組閤併腎功能異常者的比例較對照組高(P<0.05);心衰組心功能Ⅳ級者較Ⅱ級、Ⅲ級者更易閤併腎功能異常(P<0.05, P<0.01).③Pearson相關分析:心衰組UA與SCr、BUN、LVEDD、LAD,BUN與SCr、LVEDD、LAD,SCr與LVEDD、LAD呈正相關(P<0.05);而BUN與舒張壓、LVEF,eGFR與年齡、SCr、BUN、LAD呈負相關(P<0.05);偏相關分析:分彆調整心衰組年齡、性彆等因素後,UA與LVEDD(r=0.454 2,P=0.004),LAD(r=0.460 0,P=0.004),BUN與LVEF(r=-0.364 4,P=0.023)及SCr與LAD(r=0.429 3,P=0.001)仍相關.④心衰組多元逐步迴歸分析顯示:隨著 LAD、LVEDD的增加,UA升高;LVEF的下降伴有BUN升高;而LAD的增加可伴有SCr升高.⑤ROC麯線顯示SCr及eGFR對齣現中重度臨床心衰癥狀的診斷準確性分彆為0.712和0.756,且噹患者SCr＞84.05 μmol/L或eGFR＜84.845 ml·min~(-1)·1.73 m~(-2)時,就有可能伴有較重的臨床心衰癥狀.結論:擴張型心肌病心衰患者較正常人更易閤併有腎功能異常,併且隨著心髒的擴大及心功能下降伴有腎功能損害進行性加重;SCr及eGFR分彆可作為評價心衰患者疾病加重的臨床指標之一.
목적:탐토확장형심기병심력쇠갈(심쇠)환자림상증상、심공능여신공능적상호관계급기궤제.방법:장입선적101례수시자분위심쇠조(61례)화대조조(40례),여기본문권조사、체검、생화급초성심동도등검사.결과:①심쇠조심솔、혈기항(SCr)、뇨소담(BUN)、좌실서장말기내경(LVEDD)、좌방내경(LAD)급혈뇨산(UA)균고우대조조,좌실사혈분수(LVEF)화신소구려과솔(eGFR)저우정상대조조(P<0.05).②심쇠조합병신공능이상자적비례교대조조고(P<0.05);심쇠조심공능Ⅳ급자교Ⅱ급、Ⅲ급자경역합병신공능이상(P<0.05, P<0.01).③Pearson상관분석:심쇠조UA여SCr、BUN、LVEDD、LAD,BUN여SCr、LVEDD、LAD,SCr여LVEDD、LAD정정상관(P<0.05);이BUN여서장압、LVEF,eGFR여년령、SCr、BUN、LAD정부상관(P<0.05);편상관분석:분별조정심쇠조년령、성별등인소후,UA여LVEDD(r=0.454 2,P=0.004),LAD(r=0.460 0,P=0.004),BUN여LVEF(r=-0.364 4,P=0.023)급SCr여LAD(r=0.429 3,P=0.001)잉상관.④심쇠조다원축보회귀분석현시:수착 LAD、LVEDD적증가,UA승고;LVEF적하강반유BUN승고;이LAD적증가가반유SCr승고.⑤ROC곡선현시SCr급eGFR대출현중중도림상심쇠증상적진단준학성분별위0.712화0.756,차당환자SCr＞84.05 μmol/L혹eGFR＜84.845 ml·min~(-1)·1.73 m~(-2)시,취유가능반유교중적림상심쇠증상.결론:확장형심기병심쇠환자교정상인경역합병유신공능이상,병차수착심장적확대급심공능하강반유신공능손해진행성가중;SCr급eGFR분별가작위평개심쇠환자질병가중적림상지표지일.
Objiective:To explore the relationship between clinical symptoms , some examinational indexes for cardiac function and serum markers related to renal function in dilated cardiomyopathy patients with heart failure (DCM-HF), and the mechanism.Method:Sixty-one consecutive diagnosed DCM-HF and 40 with normal cardiac function were enrolled in this study. Each subject finished a questionnaire. Blood pressure, body height , weight and heart rate were measured. The information about laboratory examination and echocardiography was collected. Result:①Compared with the control group, SCr, BUN, UA and heart rate were elevated in DCM-HF.The estimated glomerular filtration rate (eGFR) were decreased(P<0.05)in DCM-HF. By the examination of echocardiography, LVEDD and LAD were larger and LVEF were lower(P<0.01)in DCM-HF than that in the control group. ②Compared to control group, DCM-HF proned to have renal dysfunction. Within DCM-HF, patients in NYHA Ⅳ were more likely to have renal dysfunction than patients in NYHA Ⅱor Ⅲ. ③Pearson correlation analysis in DCM-HF showed that there was correlations between:1) UA and SCr, BUN , LVEDD ,LAD; BUN and DBP, SCr, LVEDD, LAD , LVEF; SCr and LVEDD , LAD(P<0.05); EGFR and age, SCr,BUN ,LAD(P<0.05). Partial correlation analysis revealed that after adjusting for other relative factors UA was still correlated with LVEDD(r=0.454 2,P=0.004)and LAD(r=0.460 0,P=0.004); BUN was correlated withLVEF(r=-0.364 4,P=0.023); SCr was correlated with LAD(r=0.429 3,P=0.001). ④Multivariate regression analysis showed that in DCM-HF LAD and LVEDD were affecting factors to UA; LVEF could affect BUN; LAD were contributing factors to SCr. ⑤ROC curve revealed that SCr and eGFR have special prognostic value for the aggravated symptoms of heart failure.Conclusion:We can find more cases with renal dysfunction in DCM-HF than healthy people.The enlargement of heart and exacerbated heart failure can lead to unfavorable changes in renal function. SCr and eGFR have special prognostic value to the aggravated symptoms of heart failure.
