慢性肾脏病患者心包积液的临床特征和预后分析
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摘要
目的:分析慢性肾脏病伴心包积液患者的临床特征和影响因素,并研究其与预后的关系。方法:纳入在我院治疗的慢性肾脏病患者,分为心包积液组(139例)和无心包积液组(142例),比较两组的临床特征,分析心包积液的危险因素;随访12个月因心血管疾病再次入院和心源性死亡事件,分析其影响因素。结果:与无心包积液组比较,心包积液组钾离子(K+)、血尿素氮(BUN)、肌酐(Cr)浓度较高,而钙离子(Ca2+)、血红蛋白(Hb)、肾小球滤过率(GFR)、白蛋白水平均较低,差异均有统计学意义(均P<0.01);Logistic回归分析显示,快心率(OR:1.43;95%CI:1.04～1.98)、高K+(OR:2.14;95%CI:1.32～3.17)、高Ca2+(OR:1.37;95%CI:1.09～1.76)、低白蛋白(OR:1.86;95%CI:1.22～2.93)是心包积液的危险因素(均P<0.05)。随访结果显示,心包积液显著增加因心血管疾病再次入院率(58/139∶41/142,P=0.02),而不增加心源性死亡率(9/139∶10/142,P=0.52)。Cox回归分析显示,中重度心包积液(HR:2.15;95%CI:1.29～3.48)、终末期肾衰竭(HR:1.76;95%CI:1.16～2.51)、高K+(HR:1.54;95%CI:1.07～2.29)、低白蛋白(HR:1.62;95%CI:1.14～2.37)是12个月联合事件的独立危险因素(均P<0.05)。结论:慢性肾脏病患者心包积液与快心率、高K+、高Ca2+、低白蛋白相关,心包积液增加慢性肾脏病患者12个月的因心血管疾病再次入院率,其与中重度心包积液、高K+、低白蛋白密切相关。
Objective:To investigate the clinical features,prognosis and influencing factors of chronic kidney disease combined with pericardial effusion.Method:Patients with chronic kidney disease were divided into pericardial effusion group(n=139)and non-pericardial effusion group(n=142).Clinical characteristics between two group were compared,and risk factors of pericardial effusion were analyzed.In addition,cardiovascular re-admission and cardiac death were recorded during the follow-up of 12 months.Finally,influencing factors were analyzed.Result:Compared with those in the non-pericardial effusion group,the concentration of potassium ion(K+),blood urea nitrogen(BUN)and creatinine(Cr)in the pericardial effusion group were higher,while the levels of calcium ion(Ca2+),hemoglobin(Hb),glomerular filtration rate(GFR)and albumin were lower in the pericardial effusion group(all P<0.01).Logistic regression analysis showed that fast heart rate(OR:1.43;95%CI:1.04-1.9),high K+(OR:2.14;95%CI:1.32-3.17),high Ca2+(OR:1.37;95%CI:1.09-1.76)and low albumin(OR:1.86;95%CI:1.22-2.93)were risk factors for pericardial effusion(all P<0.05).Follow-up results showed that pericardial effusion significantly increased the rate of re-hospitalization due to cardiovascular diseases(58/139 vs.41/142,P=0.02),but did not increase cardiac mortality(9/13 vs.10/142,P=0.52).Cox regression analysis showed that moderate to severe pericardial effusion(HR:2.15;95%CI:1.29-3.48),end-stage renal failure(HR:1.76;95%CI:1.16-2.51),high K+(HR:1.54;95%CI:1.07-2.29),low albumin(HR:1.62;95%CI:1.14-2.37)were independent risk factors for 12-month combined events(all P<0.05).Conclusion:Pericardial effusion is associated with fast heart rate,high K+,high Ca2+and low albumin in patients with chronic kidney disease.Pericardial effusion increases the rate of re-hospitalization within 12 months due to cardiovascular diseases.Moderate to severe pericardial effusion,high K+,and low albumin are independent risk factor.
Objective:To investigate the clinical features,prognosis and influencing factors of chronic kidney disease combined with pericardial effusion.Method:Patients with chronic kidney disease were divided into pericardial effusion group(n=139)and non-pericardial effusion group(n=142).Clinical characteristics between two group were compared,and risk factors of pericardial effusion were analyzed.In addition,cardiovascular re-admission and cardiac death were recorded during the follow-up of 12 months.Finally,influencing factors were analyzed.Result:Compared with those in the non-pericardial effusion group,the concentration of potassium ion(K+),blood urea nitrogen(BUN)and creatinine(Cr)in the pericardial effusion group were higher,while the levels of calcium ion(Ca2+),hemoglobin(Hb),glomerular filtration rate(GFR)and albumin were lower in the pericardial effusion group(all P<0.01).Logistic regression analysis showed that fast heart rate(OR:1.43;95%CI:1.04-1.9),high K+(OR:2.14;95%CI:1.32-3.17),high Ca2+(OR:1.37;95%CI:1.09-1.76)and low albumin(OR:1.86;95%CI:1.22-2.93)were risk factors for pericardial effusion(all P<0.05).Follow-up results showed that pericardial effusion significantly increased the rate of re-hospitalization due to cardiovascular diseases(58/139 vs.41/142,P=0.02),but did not increase cardiac mortality(9/13 vs.10/142,P=0.52).Cox regression analysis showed that moderate to severe pericardial effusion(HR:2.15;95%CI:1.29-3.48),end-stage renal failure(HR:1.76;95%CI:1.16-2.51),high K+(HR:1.54;95%CI:1.07-2.29),low albumin(HR:1.62;95%CI:1.14-2.37)were independent risk factors for 12-month combined events(all P<0.05).Conclusion:Pericardial effusion is associated with fast heart rate,high K+,high Ca2+and low albumin in patients with chronic kidney disease.Pericardial effusion increases the rate of re-hospitalization within 12 months due to cardiovascular diseases.Moderate to severe pericardial effusion,high K+,and low albumin are independent risk factor.
引文
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[7]邓改芬,靳文英,朱天刚.多因素心包积液患者的临床特点分析[J].中华老年心脑血管病杂志,2017,19(2):160-162.
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[9]Mitiku TY,Heidenreich PA.A small pericardial effusion is a marker of increased mortality[J].Am Heart J,2011,161(1):152-157.
[2]Dad T,Sarnak MJ.Pericarditis and pericardial effusions in end-stage renal disease[J].Semin Dial,2016,29(5):366-373.
[3]Rehman KA,Betancor J,Xu B,et al.Uremic pericarditis,pericardial effusion,and constrictive pericarditis in end-stage renal disease:Insights and pathophysiology[J].Clin Cardiol,2017,40(10):839-846.
[4]Inker LA,Astor BC,Fox CH,et al.KDOQI US commentary on the 2012KDIGO clinical practice guideline for the evaluation and management of CKD[J].Am JKidney Dis,2014,63(5):713-735.
[5]Adler Y,Charron P,Imazio M,et al.2015ESC Guidelines for the diagnosis and management of pericardial diseases[J].Rev Esp Cardiol(Engl Ed),2015,68(12):1126.
[6]张德强,李虹伟.1型心肾综合征的研究进展[J].中华肾脏病杂志,2018,34(10):791-795.
[7]邓改芬,靳文英,朱天刚.多因素心包积液患者的临床特点分析[J].中华老年心脑血管病杂志,2017,19(2):160-162.
[8]Kleynberg RL,Kleynberg VM,Kleynberg LM,et al.Chronic constrictive pericarditis in association with end-stage renal disease[J].Int J Nephrol,2011:469602.
[9]Mitiku TY,Heidenreich PA.A small pericardial effusion is a marker of increased mortality[J].Am Heart J,2011,161(1):152-157.