不同类型心力衰竭患者肝肾功能损害及其与NT-pro-BNP相关性分析

发布时间：2018-04-12 14:06

本文选题：慢性心力衰竭 + 肝功能损害　；参考：《华北理工大学》2015年硕士论文

【摘要】：目的分析不同类型(射血分数降低和射血分数保留)心力衰竭(Chronic heart failure,CHF)患者基础病因、临床特征,评价N-末端脑钠肽(NT-pro-BNP)水平、肝肾功能损害等多脏器功能损害的患病情况,探讨肝肾功能损害与NT-pro-BNP的相关性。方法1采取回顾性研究的方法选取2013年6月至2014年10月于华北理工大学附属医院住院治疗的慢性心衰患者作为研究对象,根据纳入排除标准,本研究纳入284例患者,分别记录患者首次入院时的临床特征,包括:一般资料、基础病因、合并疾病、临床表现、化验指标及超声心动图结果。2将入选患者根据LVEF分为2组,分析比较2组患者基础病因、临床特征、NT-pro-BNP水平、血脂、血糖、肝、肾功能水平,评价肝功能损害、肾功能不全等多脏器功能损害的患病情况。3本研究数据采用Epidate软件建立数据库,统计软件SPSS17.0对数据进行分析,所有正态分布的计量数据以均数±标准差表示,两组间比较采用独立样本t检验,多组间比较采用单因素方差分析,计数资料用[例(%)]表示,组间比较用χ2检验,偏态分布的计量资料以M(Q1-Q3)表示,组间比较采用Mann-whitney检验。相关性分析采用Pearson相关系数、多元逐步线性回归分析法。以P0.05(双侧)为差异有统计学意义。结果1 284例心衰患者男性152例(53.5%),女性132例(46.5%),平均年龄(66.92±12.25)岁。HF-REF组148例(52.1%),男性92例(62.2%),平均年龄(66.20±11.54)岁;HF-PEF组136例(47.9%),男性60例(44.1%),平均年龄(67.69±12.93)岁。心功能分级:Ⅱ级26例(9.2%),Ⅲ级124例(43.7%),Ⅳ级134例(47.2%)。2基础病因分析:冠心病206例(72.5%),高血压性心脏病44例(15.5%);其他:心肌病18例(6.3%),瓣膜病14例(4.9%),先心病2例(0.7%);合并疾病:陈旧性心梗152例(53.9%),高血压209例(73.6%),糖尿病146例(51.4%)。其中HF-REF组冠心病114例(77.0%),HF-PEF 92例(67.6%),P0.05;HF-REF组高心病16例(10.8%),HF-PEF组28例(20.6%),P0.05;。3 HF-REF组患者NT-proBNP中位数为9377.23(5784.72~19579.73),HF-PEF组患者NT-pro-BNP中位数为1714.25(197.48~3562.87),P0.05。4多器官功能损害患者中,肝功能受损者41例(14.4%),肾功能不全者146例(51.4%);其中HF-REF组肝功能损害、肾功能不全的患病情况为19.6%、59.5%,HF-PEF组为18.8%、26.4%,P0.05。HF-REF组Cr、BUN、TBIL、DBIL、ALT、AST水平较HF-PEF组升高,HF-PEF组ALB、GFR水平较HF-REF组高,P0.05。5以NT-pro-BNP为因变量,以肝肾功能指标为自变量进行Pearson相关分析。NT-pro-BNP水平与TBIL、ALT、AST、Cr水平呈正相关,(P0.05);与GFR水平呈负相关,(P0.05)。将各指标进行多元逐步线性回归分析,NT-pro-BNP与TBIL呈正相关(P0.05),与Cr亦呈正相关(P0.05),。结论1不同类型心力衰竭患者的基础病因为冠心病,其次为高血压性心脏病。2HFREF组NT-pro-BNP水平高于HF-PEF组,且HFREF组肝功能损害、肾功能不全的患病情况更高。3 TBIL、Cr对判断心衰的严重程度具有一定的评估价值。
[Abstract]:Objective to analyze the basic etiology and clinical features of patients with different types of heart failure (decreased ejection fraction and retention of ejection fraction), and to evaluate the prevalence of multiple organ dysfunction such as NT-pro-BNPs, liver and kidney dysfunction, and so on.To investigate the correlation between liver and kidney function damage and NT-pro-BNP.Methods 1 A retrospective study was conducted on 284 patients with chronic heart failure who were hospitalized in affiliated Hospital of North China University of Science and Technology from June 2013 to October 2014.The clinical features of the patients at first admission were recorded, including general data, underlying causes, complicated diseases, clinical manifestations, laboratory parameters and echocardiographic results. 2. 2 patients were divided into 2 groups according to LVEF.The basic etiology, clinical features of NT-pro-BNP, blood lipids, blood glucose, liver and renal function were analyzed and compared between the two groups.The data of this study were established by Epidate software. The data were analyzed by statistical software SPSS17.0. All the normal distribution data were expressed as mean 卤standard deviation.Independent sample t test was used for comparison between two groups, single factor analysis of variance was used for multigroup comparison, 蠂 2 test was used for cross-group comparison, and Mann-whitney test was used for metrological data of skew distribution.Correlation analysis was based on Pearson correlation coefficient and multiple stepwise linear regression analysis.There was significant difference in P 0.05 (bilateral).There were 152 cases with old myocardial infarction, 209 cases with hypertension and 73.6% with diabetes, and 146 cases with diabetes.Using liver and kidney function as the independent variable, the Pearson correlation analysis. NT-pro-BNP level was positively correlated with the level of TBILL alt ASTN Cr and negatively correlated with the level of GFR.NT-pro-BNP was positively correlated with TBIL (P 0.05) and Cr was positively correlated with Cr (P 0.05) by multivariate stepwise linear regression analysis.Conclusion (1) Coronary heart disease is the basic cause of different types of heart failure, followed by NT-pro-BNP level in hypertensive heart disease .2HFREF group is higher than that in HF-PEF group, and liver function is damaged in HFREF group.The prevalence of renal insufficiency is higher. 3. 3 TBILN Cr has certain value in evaluating the severity of heart failure.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.6

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