肾功能不全对舒张性心功能不全患者预后影响
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摘要
目的舒张性心功能不全患者预后差别较大,肾功能不全与氨基末端脑钠肽前体(N terminal pro B type natriuretic peptide,NT-proBNP)均被报道与收缩性心功能患者的预后相关,但两者与舒张性心功能不全预后的关系鲜见报道。本研究探讨NT-proBNP与肾功能不全对舒张性心功能不全患者预后的影响。方法选择2012-01-01-2016-06-01辽宁省人民医院收治的153例舒张性心功能不全患者作为研究对象,同时检测NT-proBNP和肌酐清除率(creatinine clearance rate,GFR),将GRF<60mL/(min·1.73m~2)定义为肾功能不全。评估肾功能与NT-proBNP的关系及两者对患者预后的影响,终点事件为2年总死亡率。结果年龄(t=31.496,P<0.001)、性别(χ~2=5.982,P=0.014)、糖尿病史(χ~2=13.316,P<0.001)、高血压史(χ~2=9.856,P=0.002)、血红蛋白水平(t=21.373,P<0.001)、肌酐水平(t=28.642,P<0.001)和NT-proBNP水平(t=35.412,P<0.001)与GFR有关联。肾功能不全组2年总死亡率为26.3%,高于肾功能正常组的10.9%,P=0.035。多因素回归分析显示,在考虑到肾功能不全的因素之后,NT-proBNP增高仍与预后相关,HR=2.08,95%CI为1.07～3.75,P=0.018。结论肾功能不全、NT-proBNP增高的舒张性心功能不全患者预后差。肾功能不全是最简便的预后判断指标,NT-proBNP可作为辅助指标。
OBJECTIVE The prognosis of patients with diastolic cardiac insufficiency is quite different.Renal insufficiency and N terminal pro B type natriuretic peptide(NT-proBNP)have been reported to be related to the prognosis of patients with systolic cardiac function,but the relationship between them and the prognosis of diastolic cardiac insufficiency has not been reported.This study is to investigate the effects of NT-proBNP and renal insufficiency on the prognosis of patients with diastolic cardiac insufficiency.METHODS A total of 153 patients with diastolic cardiac insufficiency admitted to Liaoning People's Hospital from January 2012 to June 2016 were selected as the study subjects.NT-proBNP and creatinine clearance rate(GFR)were measured simultaneously.GRF<60 ml/(min·1.73 m2)was defined as renal insufficiency.To assess the relationship between renal function and NT-proBNP and their impact on the prognosis of patients,the end-point event was the two-year total mortality rate.RESULTS Age(t=31.496,P<0.001),sex(χ~2=5.982,P=0.014),history of diabetes(χ~2=13.316,P<0.001),history of hypertension(χ~2=9.856,P=0.002),hemoglobin level(t=21.373,P<0.001),creatinine level(t=28.642,P<0.001)and NT-proBNP level(t=35.412,P<0.001)were associated with GFR.The 2-year mortality rate of renal insufficiency group was 26.3%,higher than that of normal renal function group(10.9%,P=0.035).Multivariate regression analysis showed that the increase of NT-proBNP was still correlated with prognosis(HR=2.08,95%CI:1.07-3.75,P=0.018)after considering the factors of renal insufficiency.CONCLUSIONS Renal dysfunction and high NT-proBNP are associated with a poor prognosis in patients with diastolic heart failure.Renal dysfunction is the simplest prognostic indicator,and may be a more accurate prognostic indicator with NT-proBNP.
OBJECTIVE The prognosis of patients with diastolic cardiac insufficiency is quite different.Renal insufficiency and N terminal pro B type natriuretic peptide(NT-proBNP)have been reported to be related to the prognosis of patients with systolic cardiac function,but the relationship between them and the prognosis of diastolic cardiac insufficiency has not been reported.This study is to investigate the effects of NT-proBNP and renal insufficiency on the prognosis of patients with diastolic cardiac insufficiency.METHODS A total of 153 patients with diastolic cardiac insufficiency admitted to Liaoning People's Hospital from January 2012 to June 2016 were selected as the study subjects.NT-proBNP and creatinine clearance rate(GFR)were measured simultaneously.GRF<60 ml/(min·1.73 m2)was defined as renal insufficiency.To assess the relationship between renal function and NT-proBNP and their impact on the prognosis of patients,the end-point event was the two-year total mortality rate.RESULTS Age(t=31.496,P<0.001),sex(χ~2=5.982,P=0.014),history of diabetes(χ~2=13.316,P<0.001),history of hypertension(χ~2=9.856,P=0.002),hemoglobin level(t=21.373,P<0.001),creatinine level(t=28.642,P<0.001)and NT-proBNP level(t=35.412,P<0.001)were associated with GFR.The 2-year mortality rate of renal insufficiency group was 26.3%,higher than that of normal renal function group(10.9%,P=0.035).Multivariate regression analysis showed that the increase of NT-proBNP was still correlated with prognosis(HR=2.08,95%CI:1.07-3.75,P=0.018)after considering the factors of renal insufficiency.CONCLUSIONS Renal dysfunction and high NT-proBNP are associated with a poor prognosis in patients with diastolic heart failure.Renal dysfunction is the simplest prognostic indicator,and may be a more accurate prognostic indicator with NT-proBNP.
引文
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[13]Pan Y,Li D,Ma J,et al.NT-proBNP test with improved accuracy for the diagnosis of chronic heart failure[J].Medicine(Baltimore),2017,96(51):e9181.
[14]Merlini G,Lousada I,Ando Y,et al.Rationale,application and clinical qualification for NT-proBNP as a surrogate end point in pivotal clinical trials in patients with AL amyloidosis[J].Leukemia,2016,30(10):1979-1986.
[2]John K,Denys S,Jacques R,et al.The physiopathology of cardiorenal syndrome:A review of the potential contributions of inflammation[J].J Cardiovasc Dev Dis,2017,4(4):21.
[3]冷文修,何昆仑,范利,等.BNP和NT-proBNP在鉴别舒张性心力衰竭中的应用研究[J].中华检验医学杂志,2010,33(4):328-332.
[4]姜仲卓,李占全.肾功能不全对扩张型心肌病患者左室功能及预后的影响[J].疑难病杂志,2013,12(3):190-191.
[5]段慧.慢性心力衰竭合并肾功能不全住院患者270例临床分析[J].中国心血管病研究,2012,10(3):208-210
[6]Richards AM.N-terminal B-type natriuretic peptide in heart failure[J].Heart Fail Clin,2018,14(1):27-39.
[7]Vaes B,Delgado V,Bax J,et al.Diagnostic accuracy of plasma NT-proBNP levels for excluding cardiac abnormalities in the very elderly[J].BMC Geriatr,2010,10:85.
[8]姜仲卓,曲海波,李占全.急性左心功能衰竭患者合并贫血的临床观察[J].中华全科医学,2014,12(2):314-315.
[9]Lüscher TF.Risk factors for chronic heart failure:Obesity,renal dysfunction,arteriovenous fistulas,and amyloid deposition[J].Eur Heart J,2017,38(24):1857-1860.
[10]Ibrahim NE,Gaggin HK,Rabideau DJ,et al.Worsening renal function during management for chronic heart failure with reduced ejection fraction:Results from the Pro-BNP outpatient tailored chronic heart failure therapy(PROTECT)study[J].J Card Fail,2017,23(2):121-130.
[11]Rusinaru D,Buiciuc O,Houpe D,et al.Renal function and long-term survival after hospital discharge in heart failure with preserved ejection fraction[J].Int J Cardiol,2011,147(2):278-282.
[12]Beldhuis IE,Streng KW,Ter Maaten JM,et al.Renin-angiotensin system inhibition,worsening renal function,and outcome in heart failure patients with reduced and preserved ejection fraction:A meta-analysis of published study data[J].Circ Heart Fail,2017,10(2):e003588.
[13]Pan Y,Li D,Ma J,et al.NT-proBNP test with improved accuracy for the diagnosis of chronic heart failure[J].Medicine(Baltimore),2017,96(51):e9181.
[14]Merlini G,Lousada I,Ando Y,et al.Rationale,application and clinical qualification for NT-proBNP as a surrogate end point in pivotal clinical trials in patients with AL amyloidosis[J].Leukemia,2016,30(10):1979-1986.