慢性心力衰竭患者8年生存的肾功能相关指标影响因素分析

发布时间：2018-05-10 08:48

本文选题：心力衰竭 + 肾功能试验　；参考：《中国循环杂志》2017年03期

【摘要】：目的:采用血清肾功能相关参数及临床基线分析预测慢性心力衰竭(心衰)患者8年生存风险。方法:入选我院2006-07至2009-11期间在我院因慢性心衰急性发作入院,并随访至2014-06-30(以患者随访期间内死亡为该研究的终点)的患者293例。均接受常规肾功能、电解质检验,检验参数包括尿素氮、肌酐、尿酸、血钠、血钾、血氯、血钙、阴离子间隙和血磷指标,应用改良MDRD公式计算肾小球滤过率,并对患者行血压及彩色超声心动图检查,获取患者临床基线参数(包括左心室舒张末期内径、左心室射血分数、血压及心率),并对以上15项参数结果分组[按照随访结果将患者分为存活组(107例)和死亡组(186例)],对慢性心衰患者进行8年内生存分析。结果:与存活组比较,死亡组患者的左心室舒张末期内径、尿素氮、肌酐及尿酸升高,而左心室射血分数、心率、肾小球滤过率、血钠及血钙降低,差异均有统计学意义(P均0.05)。单因素分析结果显示,左心室舒张末期内径、左心室射血分数、肾小球滤过率、尿素氮、肌酐、尿酸、血钠、血钙、血磷对慢性心衰患者8年内生存分析风险有较好的预测价值(P均0.05)。多因素分析结果显示:左心室舒张末期内径、肾小球滤过率及血钠对慢性心衰患者8年内生存分析风险预测价值最大(P均0.001),其次为血钙(P均0.01)。结论:左心室舒张末期内径、左心室射血分数、肾小球滤过率、尿素氮、肌酐、尿酸、血钠、血钙为慢性心衰患者8年内生存分析的特异指标,Cox分析显示左心室舒张末期内径、肾小球滤过率、血钠、血钙为预测慢性心衰患者8年内生存分析的独立危险因素。
[Abstract]:Objective: to predict the 8-year survival risk of patients with chronic heart failure (CHF) by serum renal function related parameters and clinical baseline analysis. Methods: 293 patients who were admitted to our hospital from 2006-07 to 2009-11 for acute attack of chronic heart failure were followed up to 2014-06-30 (with death during follow-up period as the end point of the study). All of them were examined by routine renal function and electrolytes. The parameters included urea nitrogen, creatinine, uric acid, blood sodium, blood potassium, blood chlorine, blood calcium, anion gap and blood phosphorus index. The glomerular filtration rate was calculated by modified MDRD formula. The clinical baseline parameters (including left ventricular end-diastolic diameter, left ventricular ejection fraction, left ventricular ejection fraction) were obtained by blood pressure and color echocardiography. Blood pressure and heart rate were divided into 15 parameters (107 patients in survival group and 186 patients in death group according to the follow-up results). The survival of patients with chronic heart failure within 8 years was analyzed. Results: compared with the survival group, the left ventricular end-diastolic diameter, urea nitrogen, creatinine and uric acid increased in the death group, while the left ventricular ejection fraction, heart rate, glomerular filtration rate, blood sodium and serum calcium decreased significantly (P < 0.05). Univariate analysis showed that left ventricular end-diastolic diameter, left ventricular ejection fraction, glomerular filtration rate, urea nitrogen, creatinine, uric acid, blood sodium, blood calcium, Blood phosphorus has a good predictive value for survival analysis risk of patients with chronic heart failure within 8 years (P < 0.05). The results of multivariate analysis showed that left ventricular end-diastolic diameter, glomerular filtration rate and blood sodium had the highest predictive value for survival analysis of patients with chronic heart failure within 8 years (P 0.001), followed by blood calcium. Conclusion: left ventricular end-diastolic diameter, left ventricular ejection fraction, glomerular filtration rate, urea nitrogen, creatinine, uric acid, blood sodium and blood calcium are the specific indexes of survival analysis in patients with chronic heart failure within 8 years. Cox analysis shows left ventricular end-diastolic diameter. Glomerular filtration rate, blood sodium and serum calcium were independent risk factors for 8-year survival analysis in patients with chronic heart failure.
【作者单位】：潍坊医学院;山东省千佛山医院心内科;济南市中心医院心内科;烟台毓璜顶医院神经外科监护室;
【基金】：2014年山东省科技发展计划(2014GSF118187)
【分类号】：R541.6

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