慢性心力衰竭合并肾功能不全相关危险因素分析

发布时间：2018-04-10 09:26

本文选题：慢性心力衰竭　切入点：肾功能不全　出处：《石河子大学》2017年硕士论文

【摘要】：目的:分析慢性心力衰竭患者合并肾功能不全的临床特点,探讨慢性心力衰竭患者伴发肾功能不全可能的危险因素。方法:采用回顾性研究的方法,收集整理2014年1月-2016年8月就诊于石河子大学医学院第一附属医院心内科符合NYHA心功能Ⅲ~Ⅳ级的慢性心力衰竭患者385例,其中男性211例,女性174例,平均年龄69.62±8.59岁。按照肾小球滤过率估计值(e GFR)将入选的慢性心力衰竭患者分为肾功能不全组[e GFR60 m L/(min·1.73 m2)]和非肾功能不全组[e GFR≥60 m L/(min·1.73 m2)],分析比较两组患者的一般资料、心脏基础疾病和伴随疾病、对比剂应用史、心脏超声参数、肾功能指标、血脂、NT-pro BNP、血红蛋白、尿微量白蛋白等实验室检查结果,Logistic回归分析慢性心力衰竭患者发生肾功能不全的独立危险因素。结果:385例慢性心力衰竭患者中发生肾功能不全的比例约42.1%。肾功能不全组和非肾功能不全组相比,年龄、NYHA心功能分级、高血压病史、糖尿病史、合并贫血、合并心房颤动在两组之间的差异有统计学意义(P0.05);肾功能不全组血清肌酐、尿素氮、尿酸、胱抑素C和NT-pro BNP水平以及利尿剂的应用比例较非肾功能不全组高;LVEF、血红蛋白水平及ACEI类药物的应用比例较非肾功能不全组降低,差异有统计学意义(P0.05)。单因素logistic回归分析显示,高龄、NYHA心功能Ⅳ级、高血压病史、糖尿病病史、合并贫血、血清高肌酐水平、高尿素氮水平、高胱抑素C水平、高NT-pro BNP水平以及利尿剂的应用为肾功能不全的危险因素(OR1,P0.05)。多因素Logistic回归分析显示,高龄(OR 1.454,95%CI 1.099~1.925)、NYHA心功能IV级(OR 1.940,95%CI 1.142~3.295)、既往高血压病史(OR 1.617,95%CI 1.009~2.591)、合并贫血(OR 1.903,95%CI 1.151~3.145)、血高尿素氮水平(OR 2.130,95%CI1.266~3.584)、高胱抑素C水平(OR 2.306,95%CI 1.262~4.214)以及利尿剂的使用(OR 2.433,95%CI 1.042~5.679)与肾功能不全的发生独立相关。结论:慢性心力衰竭患者中肾功能不全的发生比例较高,高龄、NYHA心功能Ⅳ级、高血压病史、合并贫血、高血尿素氮水平、高胱抑素C水平及利尿剂的使用是慢性心力衰竭患者发生肾功能不全的独立危险因素。
[Abstract]:Objective: to analyze the clinical characteristics of the patients with renal insufficiency in patients with chronic heart failure, explore the risk factors of renal dysfunction may be associated with chronic heart failure patients. Methods: a retrospective study method, collected in January 2014 -2016 year in August in the Department of Cardiology of the First Affiliated Hospital of Shihezi University School of medicine in accordance with heart function in patients with chronic heart failure NYHA III ~ IV grade 385 cases, including 211 cases of male, female 174 cases, mean age 69.62 + 8.59 years. According to the estimated glomerular filtration rate (E, GFR) in patients with chronic heart failure were selected and divided into renal insufficiency group [e GFR60 m L/ (min - 1.73 m2)] and non renal dysfunction group [e GFR = 60 m L/ (min - 1.73 m2)], to analyze the general information of the two groups were compared, heart diseases and diseases associated with the history of application, contrast agent, echocardiographic parameters, renal function, blood lipids, hemoglobin, urine NT-pro BNP. The examination results of albumin in laboratory, Logistic regression analysis of independent risk factors of renal dysfunction in patients with chronic heart failure. Results: 385 cases of chronic heart failure in patients with renal insufficiency of 42.1%. renal dysfunction group and non renal insufficiency group than age, NYHA grade of heart function, hypertension the history of diabetes, anemia, fibrillation, differences between the two groups in the atrial was statistically significant (P0.05); renal insufficiency group, serum creatinine, urea nitrogen, uric acid, NT-pro and BNP levels of cystatin C and diuretic agent application compared with non renal insufficiency group; LVEF, the proportion of hemoglobin level and application ACEI drugs than in non renal insufficiency group decreased, the difference was statistically significant (P0.05). Single factor Logistic regression analysis showed that age, NYHA cardiac function grade, disease history, hypertension, history of diabetes, with poor Blood serum creatinine, high level, high urea nitrogen level, the high level of cystatin C, high NT-pro BNP level and the use of diuretics were risk factors of renal dysfunction (OR1, P0.05). Logistic regression analysis showed that age (OR 1.454,95%CI 1.099~1.925), NYHA (OR 1.940,95%CI heart function class IV 1.142~3.295), past history of hypertension (OR 1.617,95%CI 1.009~2.591), anemia (OR 1.903,95%CI 1.151~3.145), blood urea nitrogen level (OR 2.130,95%CI1.266~3.584), the high level of cystatin C (OR 2.306,95%CI 1.262~4.214) and the use of diuretics (OR 2.433,95%CI 1.042~5.679) and the occurrence of renal insufficiency independently. Conclusion: high proportion of kidney. Dysfunction in elderly patients with chronic heart failure, NYHA heart function grade, hypertension, anemia, high blood urea nitrogen level, the use of high levels of cystatin C and chronic diuretic An independent risk factor for renal failure in patients with heart failure.

【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.6;R692

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