Smilde Tom D J, Hillege Hans L, Navis Gerjan, Boomsma Frans, de Zeeuw Dick, van Veldhuisen Dirk J
Department of Cardiology, Thoraxcenter, University Hospital, Groningen, The Netherlands.
Am Heart J. 2004 Jul;148(1):165-72. doi: 10.1016/j.ahj.2004.02.007.
Renal dysfunction is a strong predictor of mortality in chronic heart failure (CHF). Most patients with CHF have atherosclerotic vascular disease, and several authors have suggested that impaired renal function is only a marker of advanced atherosclerosis. We compared renal function in patients with ischemic and nonischemic CHF and examined associations with prognosis and extent of neurohormonal activation.
In a large survival study (1906 patients), patients with documented coronary artery disease (CAD, n = 995), were compared with patients with idiopathic dilated cardiomyopathy (IDC, n = 429). In a smaller substudy, plasma neurohormones were determined in 270 patients and 37 patients (CAD and IDC, respectively). All patients had advanced CHF (New York Heart Association functional class III-IV). At baseline, the mean patient age was 64 +/- 10 years, and the mean left ventricular ejection fraction was 0.26 +/- 0.08. The baseline glomerular filtration rate was calculated with the Cockcroft-Gault equation (GFRc).
GFRc was a strong predictor for mortality in both groups on multivariate analysis. The relative risk was 3.04 for patients with IDC (P < or =.01, for the lowest quartile < or =53 mL/min), and the relative risk for patients with CAD was 1.81 (P =.01 for the lowest quartile < or =42 mL/min). Plasma neurohormones showed a relation with GFRc in both groups.
GFRc is related to survival and plasma neurohormones in both patient groups. In patients with IDC, this association appears to be at least as strong as in patients with CAD.
肾功能不全是慢性心力衰竭（CHF）患者死亡率的强有力预测指标。大多数CHF患者患有动脉粥样硬化性血管疾病，一些作者认为肾功能受损仅是晚期动脉粥样硬化的一个标志。我们比较了缺血性和非缺血性CHF患者的肾功能，并研究了其与预后及神经激素激活程度的关系。
在一项大型生存研究（1906例患者）中，将有冠状动脉疾病（CAD，n = 995）记录的患者与特发性扩张型心肌病（IDC，n = 429）患者进行比较。在一项较小的亚研究中，测定了270例患者和37例患者（分别为CAD和IDC患者）的血浆神经激素。所有患者均为晚期CHF（纽约心脏协会心功能分级III - IV级）。基线时，患者平均年龄为64±10岁，平均左心室射血分数为0.26±0.08。用Cockcroft - Gault方程计算基线肾小球滤过率（GFRc）。
多因素分析显示，GFRc是两组患者死亡率的强有力预测指标。IDC患者的相对风险为3.04（最低四分位数≤53 mL/min时，P≤0.01），CAD患者的相对风险为1.81（最低四分位数≤42 mL/min时，P = 0.01）。两组患者的血浆神经激素均与GFRc相关。
两组患者的GFRc均与生存率及血浆神经激素相关。在IDC患者中，这种关联似乎至少与CAD患者一样强。
