急性左心衰竭患者发生I型心肾综合征的相关危险因素分析

Risk factors for type I cardiorenal syndrome among patients with acute left heart failure

摘要:

目的探讨急性左心衰竭患者发生I型心肾综合征（I 型CRS）的相关危险因素。方法选取2012年5 月-2015 年5 月就诊于郑州大学第一附属医院心内科、肾内科、急诊科的176 例急性左心衰竭患者为研究对象。依据是否发生I 型CRS 将患者分为研究组（I型CRS 组）和对照组（非I 型CRS 组）。回顾性分析两组患者临床、生化检查及原发病史资料，并运用多因素Logistic 回归模型对急性心力衰竭患者发生I 型CRS 的相关危险因素进行分析。结果急性左心衰竭患者I 型CRS 发生率为31.81%。年龄、血红蛋白（HGB）、脑钠肽（BNP）、尿素氮（BUN）、肌酐（Scr）、尿酸（UA）、肾小球滤过率（MDRD-eGFR），扩张型心脏病、高血压、糖尿病，以及使用利尿剂、ACRI/ARB 和血管活性药物在研究组和对照组间比较差异有统计学意义（均P<0.05）。经Logistic 多因素回归分析校正其他因素后发现，MDRD-eGFR<60 ml/min、贫血、高血压、糖尿病、使用利尿剂和血管活性药物为急性左心衰竭患者发生I 型CRS 的危险因素，其风险比（OR）值分别为3.79、8.54、5.02、2.65、3.45 和1.99。结论入院时MDRD-eGFR<60 ml/min和贫血是急性心力衰竭患者发生I 型CRS 的危险因素；高血压、糖尿病、利尿剂和血管活性药物应用可增加其发病的风险。

Abstract:

Objective To explore the related risk factors for type I cardiorenal syndrome (CRS) among hospitalized patients with acute left heart failure. Methods A total of 176 cases who were hospitalized with the diagnosis of acute left heart failure in our hospital from May 2010 to May 2015 were chosen. Depending on the occurrence of type I CRS or not, the patients were divided into study group (type I CRS) and the control group (without type I CRS). The clinical and biochemical test results and the primary disease history of the two groups were retrospectively analyzed.The relating risk factors of type I CRS were analyzed in the patients. Results The incidence of type I CRS in the patients with acute left heart failure was 31.81% . Age, Hb, BNP, BUN, SCr, UA, MDRD -eGFR, dilated cardiomyopathy, hypertension, diabetes, and use of diuretics and vasoactive drugs were statistically different between the study group and the control group (P < 0.05). After adjusting other factors with logistic regression analysis,MDRD-eGFR <60 ml/min (OR = 3.795), anemia (OR = 8.542) and hypertension (OR = 5.02), diabetes (OR =2.65), use of diuretics (OR = 3.45) and vasoactive drugs (OR = 1.99) were the independent predictors of type I CRS in the patients with acute left heart failure. Conclusions Type I CRS is a common complication in patients hospitalized for acute left heart failure, and the prevalence is high. MDRD-eGFR <60 ml/min and anemia on admission are the independent risk factors of type I CRS. Hypertension, diabetes mellitus, and the use of diuretics and vasoactive drugs after admission may increase the incidence of type I CRS in patients with acute heart failure.