慢性射血分数减低的心力衰竭合并肾功能不全患者血管紧张素转化酶抑制剂/受体阻滞剂应用的影响因素分析
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摘要
目的:分析慢性射血分数减低的心力衰竭(HFrEF)合并肾功能不全住院患者应用血管紧张素转化酶抑制剂/受体阻滞剂(ACEI/ARB)的影响因素。方法:采用病例回顾的方法收集患者的住院资料。以肾小球滤过率(GFR)<60mL·min~(-1)·1.73 m~(-2)定义为肾功能不全。先分析HFrEF合并肾功不全患者应用和未应用ACEI/ARB的临床特征。然后,用二元Logistic回归分析影响HFrEF合并肾功能不全患者未应用ACEI/ARB的因素。结果:HFrEF合并肾功不全患者129例(已除外有ACEI/ARB应用禁忌证的患者)。ACEI/ARB的应用比例为64.3%。二元Logistic回归分析显示GFR<30 mL·min~(-1)·1.73 m~(-2)、无高血压病史是未应用ACEI/ARB的预测因子。结论:影响HFrEF合并肾功不全患者应用ACEI/ARB的因素为GFR<30 mL·min~(-1)·1.73 m~(-2)和无高血压病史。
Objective: To analyze the factors that influence the application of ACEI/ARB in hospitalized chronic heart failure with reduced ejection fraction(HFrEF)patients with renal dysfunction. Methods: Applying retrospective method to collect patients' hospital information. The definition of renal dysfunction is GFR<60 mL·min~(-1)·1.73m~(-2).Firstly,analyzing the clinical characteristics of chronic HFrEF patients with renal dysfunction who are treated with and without ACEI/ARB. Then analyzing the factors which influence the use of ACEI/ARB in such patients by binary Logistic analysis. Results: 129 chronic HFrEF patients with renal dysfunction(except ACEI/ARB contraindication patients.),are included in the study.The application proportion of ACEI/ARB is 64.3%.The results of binary Logistic analysis show that GFR<30 mL·min~(-1)·1.73 m~(-2),no hypertension are independent predictors for no application of ACEI/ARB. Conclusions: The factors that affect the use of ACEI/ARB in hospitalized chronic HFrEF patients with renal dysfunction are GFR<30 mL·min~(-1)·1.73 m~(-2)and no hypertension.
Objective: To analyze the factors that influence the application of ACEI/ARB in hospitalized chronic heart failure with reduced ejection fraction(HFrEF)patients with renal dysfunction. Methods: Applying retrospective method to collect patients' hospital information. The definition of renal dysfunction is GFR<60 mL·min~(-1)·1.73m~(-2).Firstly,analyzing the clinical characteristics of chronic HFrEF patients with renal dysfunction who are treated with and without ACEI/ARB. Then analyzing the factors which influence the use of ACEI/ARB in such patients by binary Logistic analysis. Results: 129 chronic HFrEF patients with renal dysfunction(except ACEI/ARB contraindication patients.),are included in the study.The application proportion of ACEI/ARB is 64.3%.The results of binary Logistic analysis show that GFR<30 mL·min~(-1)·1.73 m~(-2),no hypertension are independent predictors for no application of ACEI/ARB. Conclusions: The factors that affect the use of ACEI/ARB in hospitalized chronic HFrEF patients with renal dysfunction are GFR<30 mL·min~(-1)·1.73 m~(-2)and no hypertension.
引文
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[2] Damman K, Valente MAE, Voors AA, et al. Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis. Eur Heart J, 2014,35:455-469.
[3] McAlister FA,Ezekowitz J,Tonelli M,et al.Renal insufficiency and heart failure:prognostic and therapeutic implications from a prospective cohort study.Circulation,2004,2,109(8):1004-1009.
[4] Segall L,Nistor I,Covic A.Heart failure in patients with chronic kidney a systematic disease: integrative review.Biomed Res Int,2014,2014:937398.
[5] Clark H, Krum H, Hopper I. Worsening renal function during renin-angiotensin-aldosterone system inhibitor initiation and long-term outcomes in patients with left ventricular systolic dysfunction. Eur J Heart Fail, 2014,16:41-48.
[6] Ma YC,Zuo L,Chen m,et al.Modified glomemlar filtration rate estimating equation for Chinese patients with chronic kidney disease.J Am Soc Nephrol,2006,17(10):2937-2944.
[7] 杨艳华,王林,黄姣,等.近30年来慢性心力衰竭住院患者合并肾功能不全的回顾性分析.天津医药,2009,37(4).261-265.
[8] 中华医学会心血管病学分会心力衰竭学组,中国医师协会心力衰竭专业委员会,中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018.中华心血管病杂志,2018,46(10):760-789.
[9] Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC /AHA /HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American college of cardiology/American heart association task force on clinical practice guidelines and the heart failure society of America. Circulation, 2017, 136(6):e137-161.
[10] Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J, 2016, 37(27): 2129-2200.
[11] Damman K, Tang WH, Felker GM, et al. Current evidence on treatment of patients with chronic systolic heart failure and renal insufficiency:practical considerations from published data.J Am Coll Cardiol,2014,63(9):853-871.
[12] Acquarone N,Castello C,Antonucci G, et al. Pharmacologic therapy in patients with chronic heart failureand chronic kidney disease: a complex issue.J Cardiovasc Med, 2009,10(1):13-21.
[2] Damman K, Valente MAE, Voors AA, et al. Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis. Eur Heart J, 2014,35:455-469.
[3] McAlister FA,Ezekowitz J,Tonelli M,et al.Renal insufficiency and heart failure:prognostic and therapeutic implications from a prospective cohort study.Circulation,2004,2,109(8):1004-1009.
[4] Segall L,Nistor I,Covic A.Heart failure in patients with chronic kidney a systematic disease: integrative review.Biomed Res Int,2014,2014:937398.
[5] Clark H, Krum H, Hopper I. Worsening renal function during renin-angiotensin-aldosterone system inhibitor initiation and long-term outcomes in patients with left ventricular systolic dysfunction. Eur J Heart Fail, 2014,16:41-48.
[6] Ma YC,Zuo L,Chen m,et al.Modified glomemlar filtration rate estimating equation for Chinese patients with chronic kidney disease.J Am Soc Nephrol,2006,17(10):2937-2944.
[7] 杨艳华,王林,黄姣,等.近30年来慢性心力衰竭住院患者合并肾功能不全的回顾性分析.天津医药,2009,37(4).261-265.
[8] 中华医学会心血管病学分会心力衰竭学组,中国医师协会心力衰竭专业委员会,中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018.中华心血管病杂志,2018,46(10):760-789.
[9] Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC /AHA /HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American college of cardiology/American heart association task force on clinical practice guidelines and the heart failure society of America. Circulation, 2017, 136(6):e137-161.
[10] Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J, 2016, 37(27): 2129-2200.
[11] Damman K, Tang WH, Felker GM, et al. Current evidence on treatment of patients with chronic systolic heart failure and renal insufficiency:practical considerations from published data.J Am Coll Cardiol,2014,63(9):853-871.
[12] Acquarone N,Castello C,Antonucci G, et al. Pharmacologic therapy in patients with chronic heart failureand chronic kidney disease: a complex issue.J Cardiovasc Med, 2009,10(1):13-21.