慢性心力衰竭患者蛋白尿水平预测心脏不良事件的效果分析
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摘要
目的探讨慢性心力衰竭患者蛋白尿水平预测心脏不良事件的效果,为减少主要心脏不良事件的发生提供参考依据。方法对162例慢性心力衰竭患者的临床资料进行回顾性分析,根据有无蛋白尿分为蛋白尿组(n=64)和无蛋白尿组(n=98),比较两组患者的临床资料,并采用多因素Logistic回归分析法分析蛋白尿与慢性心力衰竭患者主要心脏不良事件的关系。结果蛋白尿组冠心病、糖尿病比例及心功能分级、LVEDD、NT-ProBNP明显高于无蛋白尿组,LVEF及β受体阻滞剂使用比例明显低于无蛋白尿组,差异均有统计学意义(P<0.05);随访6个月后,共有29例(17.90%)患者出现主要心脏不良事件,无蛋白尿组主要心脏不良事件发生率为11.22%(11/98),明显低于蛋白尿组的28.13%(18/64),差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示,蛋白尿是慢性心力衰竭患者心源性休克、心源性死亡以及心力衰竭加重再住院的独立危险因素(P<0.05)。结论蛋白尿水平对慢性心力衰竭患者病情严重程度及主要心脏不良事件预测有一定临床价值。
Objective To investigate the effect of proteinuria on the prediction of major adverse cardiac events in patients with chronic heart failure,and to provide data for reducing the occurrence of major adverse cardiac events.Methods The clinical data of 162 patients with chronic heart failure was analyzed retrospectively. According to the occurrence of proteinuria,these patients were divided into the proteinuria-free group(n = 98) and proteinuria group(n = 64). The clinical data was compared between the two groups. Multivariate Logistic regression analysis was used to analyze the relationships between proteinuria and major adverse cardiac events in patients with chronic heart failure. Results The incidence of coronary heart disease and diabetes,heart function classification,and levels of NT-ProBNP in the proteinuria group were significantly higher than those of the proteinuriafree group,while the LVEF and usage of β blockerwere significantly lower than those in the proteinuria-free group,and the differences were statistically significant(P<0.05). After six-month follow-up,a total of 29 patients(17.90%) reported major adverse cardiac events. The incidence of major adverse cardiac events was 11.22%(11/98) in the proteinuria free group,significantly lower than 28.13%(18/64) in proteinuria group,and the difference was statistically significant(P<0.05). Multivariate Logistic regression analysis showed that proteinuria was an independent risk factor for cardiogenic shock,cardiac death,and heart failure exacerbations in patients with chronic heart failure(P<0.05).Conclusion Proteinuria levels are of clinical value in predicting the severity of patients with chronic heart failure and major adverse cardiac events.
Objective To investigate the effect of proteinuria on the prediction of major adverse cardiac events in patients with chronic heart failure,and to provide data for reducing the occurrence of major adverse cardiac events.Methods The clinical data of 162 patients with chronic heart failure was analyzed retrospectively. According to the occurrence of proteinuria,these patients were divided into the proteinuria-free group(n = 98) and proteinuria group(n = 64). The clinical data was compared between the two groups. Multivariate Logistic regression analysis was used to analyze the relationships between proteinuria and major adverse cardiac events in patients with chronic heart failure. Results The incidence of coronary heart disease and diabetes,heart function classification,and levels of NT-ProBNP in the proteinuria group were significantly higher than those of the proteinuriafree group,while the LVEF and usage of β blockerwere significantly lower than those in the proteinuria-free group,and the differences were statistically significant(P<0.05). After six-month follow-up,a total of 29 patients(17.90%) reported major adverse cardiac events. The incidence of major adverse cardiac events was 11.22%(11/98) in the proteinuria free group,significantly lower than 28.13%(18/64) in proteinuria group,and the difference was statistically significant(P<0.05). Multivariate Logistic regression analysis showed that proteinuria was an independent risk factor for cardiogenic shock,cardiac death,and heart failure exacerbations in patients with chronic heart failure(P<0.05).Conclusion Proteinuria levels are of clinical value in predicting the severity of patients with chronic heart failure and major adverse cardiac events.
引文
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[11]虞莹臖,任妍,周清芬,等.蛋白尿对老年慢性心力衰竭患者心功能影响的研究[J].老年医学与保健,2013,19(4):214.
[12]TAKEISHI Y.Biomarkers in heart failure[J].Int Heart J,2014,55(6):474.
[13]BELLO A K,HEMMELGARN B,LLOYD A,et al.Associations among estimated glomerular filtration rate,proteinuria,and adverse cardiovascular outcomes[J].Clin JAm Soc Nephrol,2011,6(6):1418.
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[15]卢维晟,刘斌,王一尘.心力衰竭患者的蛋白尿和B型钠尿肽对主要不良心脏事件的影响[J].中华老年心脑血管病杂志,2016,18(7):688.
[16]陈琛,刘晓丹.老年急性心力衰竭并发心脏不良事件患者血清炎症指标的预测价值[J].牡丹江医学院学报,2017,38(4):49.
[2]INGELSSON E,SUNDSTROM J,LIND L,et al.Lowgrade albuminuria and the incidence of heart failure in a community-based cohort of elderly men[J].Eur Heart J,2007,28(14):1739.
[3]马骥,李思逸,陈林,等.血清中性粒细胞明胶酶相关脂质运载蛋白检测在造影剂肾病诊断中的临床意义[J].重庆医学,2015,44(19):2626.
[4]裴小锐.微量蛋白尿在评估慢性心力衰竭严重程度及预后中的意义[D].苏州大学,2011.
[5]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.慢性心力衰竭诊断治疗指南[J].中华心血管病杂志,2007,35(12):1076.
[6]龚敏,李涛,马爱群.慢性心力衰竭NYHA心功能分级与胰岛素抵抗相关性分析[J].陕西医学杂志,2012,41(1):50.
[7]王慧.N-末端脑钠肽前体、肌钙蛋白T、超敏C反应蛋白诊断慢性心力衰竭的临床价值探讨[J].中国医药导报,2013,10(15):127.
[8]柳学,李志莲,曾文新,等.蛋白尿对心力衰竭患者不良危重事件及预后的预测价值[J].中华医学杂志,2016,96(30):2404.
[9]ANAND I S,BISHU K,RECTOR T S,et al.Proteinuria,chronic kidney disease,and the effect of an angiotensin receptor blocker in addition to an angiotensin-converting enzyme inhibitor in patients with moderate to severe heart failure[J].Circulation,2009,120(16):1577.
[10]JACKSON C E,SOLOMON S D,GERSTEIN H C,et al.Albuminuria in chronic heart failure:prevalence and prognostic importance[J].Lancet,2009,374(9689):543.
[11]虞莹臖,任妍,周清芬,等.蛋白尿对老年慢性心力衰竭患者心功能影响的研究[J].老年医学与保健,2013,19(4):214.
[12]TAKEISHI Y.Biomarkers in heart failure[J].Int Heart J,2014,55(6):474.
[13]BELLO A K,HEMMELGARN B,LLOYD A,et al.Associations among estimated glomerular filtration rate,proteinuria,and adverse cardiovascular outcomes[J].Clin JAm Soc Nephrol,2011,6(6):1418.
[14]NEAL B,PERKOVIC V,MATTHEWS D R,et al.Rationale,design and baseline characteristics of the CANagliflozin cardio Vascular Assessment Study-Renal(CAN-VAS-R):A randomized,placebo-controlled trial[J].Diabetes Obes Metab,2017,19(3):387.
[15]卢维晟,刘斌,王一尘.心力衰竭患者的蛋白尿和B型钠尿肽对主要不良心脏事件的影响[J].中华老年心脑血管病杂志,2016,18(7):688.
[16]陈琛,刘晓丹.老年急性心力衰竭并发心脏不良事件患者血清炎症指标的预测价值[J].牡丹江医学院学报,2017,38(4):49.