摘要
目的:探讨肾功能及电解质水平变异性与慢性心力衰竭(CHF)患者预后的相关性。方法:选择CHF患者572例为研究对象,每月到门诊进行常规复诊,每2个月进行实验室检查[血清尿素氮(BUN)、肌酐(Cr)、血清电解质(Na^(+)、K^(+)、Cl^(-)、Ca^(2+)及Mg^(2+))]和心脏彩超检查[左心室射血分数(LVEF)],持续6个月。计算持续复诊期间上述指标的平均值(mean)及平均连续变异系数(ASV)作为变异性相关指标。而后对患者进行为期2年的随访,根据预后情况将患者分为预后良好组和预后不良组。比较两组一般资料、实验室检查及心脏彩超检查变异性指标。采用比例风险回归模型(Cox)分析影响患者预后的因素。结果:截至2021年6月31日随访结束,572例患者中509例患者完成各项检查及随访,完成率88.98%;预后不良患者133例,其中心血管意外43例,心脏原因急诊再入院88例,心脏原因死亡2例。最终,预后良好组376例,预后不良组133例。预后不良组SBP、DBP、NYHA分级Ⅳ级占比、卒中类疾病占比高于预后良好组(均P<0.05)。预后不良组FBG-mean、FBG-ASV、BUN-ASV、Cr-mean、Cr-ASV、Na^(+)-ASV、K^(+)-ASV、Ca^(2+)-ASV、Mg^(2+)-ASV及LVEF-ASV高于预后良好组,LVEF-mean低于预后良好组(均P<0.05)。Cox回归分析结果显示,SBP-ASV、DBP-ASV、NYHA分级Ⅳ级、FBG-ASV、BUN-ASV、Cr-ASV、K^(+)-ASV、Ca^(2+)-ASV、Mg^(2+)-ASV及LVEF-ASV是影响CHF患者预后的独立危险因素,而LVEF-mean是保护因素(均P<0.05)。结论:肾功能及电解质水平的变异性与CHF患者预后显著相关,为CHF患者长期管理提供了新的参考方向。
Objective:To investigate the correlation between the variability of renal function and electrolyte levels and the prognosis of patients with chronic heart failure(CHF).Methods:A total of 572 patients with CHF were selected as the research object.They went to the outpatient department for routine follow-up every month.Laboratory tests[serum urea nitrogen(BUN),creatinine(Cr),serum electrolytes(Na^(+),K^(+),Cl^(-),Ca^(2+)and Mg^(2+))]and color Doppler echocardiography[left ventricular ejection fraction(LVEF)]were performed every 2 months foR6 months.The mean and the average continuous coefficient of variation(ASV)of the above indicators were calculated as the variability related indicators during the continuous follow-up visit.Then the patients were followed up foR2 years,and were divided into good prognosis group and poor prognosis group according to the prognosis.The general data,the variability of laboratory tests and cardiac color Doppler echocardiography were compared between the two groups.of Factors affecting the prognosis of patients was analyed by Cox.Results:By the end of follow-up on June 31,2021,509 of 572 patients had completed various examinations and follow-up,with a completion rate of 88.98%;133 patients had poor prognosis,including 43 cardiovascular accidents,88 emergency readmissions due to cardiac causes,and 2 deaths due to cardiac causes.Finally,376 patients had good prognosis and 133 patients had poor prognosis.The proportions of SBP,DBP,NYHA gradeⅣand stroke in poor prognosis group were higher than those in good prognosis group(all P<0.05).The FBG-mean、FBG-ASV、BUN-ASV、Cr-mean、Cr-ASV、Na^(+)-ASV、K^(+)-ASV、Ca^(2+)-ASV、Mg^(2+)-ASV and LVEF-ASV in poor prognosis group were higher than those in good prognosis group,LVEF mean was lower than that in good prognosis group(all P<0.05).Cox regression analysis showed that SBP-ASV、DBP-ASV、NYHA gradeⅣ、FBG-ASV、BUN-ASV、Cr-ASV、K^(+)-ASV、Ca^(2+)-ASV、Mg^(2+)-ASV and LVEF-ASV were independent risk factors for prognosis of patient
作者
屈慧
李娅
QU Hui;LI Ya(Department of Laboratory,Xijing Hospital,Air Force Medical University,Xi’an 710032,China)
出处
《陕西医学杂志》
CAS
2023年第3期287-291,共5页
Shaanxi Medical Journal
基金
陕西省科技厅一般项目-社会发展领域(2022SF-289)。
关键词
慢性心力衰竭
肾功能
电解质
预后分析
相关性
Chronic heart failure
Renal function
Electrolyte
Prognostic analysis
Correlation
