Shutov A M, Kurzina E V, Serov V A, Ivashkina T N
Klin Med (Mosk). 2008;86(9):32-5.
The objective of this study was to elucidate the relationship between mitral regurgitation (MR) and the glomerular filtration rate (GFR) in patients with chronic heart failure (CHF). A total of 340 patients with CHF (200 men and 140 women, mean age 58.0 +/- 12.9 years) were included in the study. Arterial hypertension (AH) was the cause of CHF in 44 (13%) patients, coronary heart disease in 112 (33%) patients, and combination of the two disorders in 184 (54%) patients. CHF of functional classes I and II was diagnosed in 112 (33%) and 177 (53%) patients respectively, CHF of functional classes III and IV in 34 (10%) and 17 (5%) patients. GFR was calculated using the MDRD formula. The left ventricular ejection fraction (EF) was 56.9 +/- 10.5%. Systolic dysfunction occurred in 90 (26%) patients and mitral regurgitation in 221 (65%). GFR varied from 19.2 to 149.7 (mean 68.8 +/- 2.9) ml/min/1.73 m2. CRF was below 60 ml/min/1.73 m2 in 114 (34%) patients. There was significant positive correlation between the occurrence of MR and the functional class of CHF (r = 0.35; p < 0.001) while GFR was inversely related to MR (r = -0.43; p < 0.001). Multifactor regression analysis demonstrated that manifestation of MR was associated with the decreased functional activity of the kidneys regardless of the patients" age. It is concluded that changes in the structure of the echo signal from the mitral valve in patients with CHF due to coronary heart disease and/or arterial hypertension are most common in patients with GFR below 60 ml/min/1.73 m2. The degree of MR manifestation is closely associated with the impaired functional activity of the kidneys.
本研究的目的是阐明慢性心力衰竭（CHF）患者二尖瓣反流（MR）与肾小球滤过率（GFR）之间的关系。共有340例CHF患者（200例男性和140例女性，平均年龄58.0±12.9岁）纳入本研究。44例（13%）患者因动脉高血压（AH）导致CHF，112例（33%）患者因冠心病导致CHF，184例（54%）患者因两种疾病共同导致CHF。分别有112例（33%）和177例（53%）患者被诊断为I级和II级功能性CHF，34例（10%）和17例（5%）患者被诊断为III级和IV级功能性CHF。GFR采用MDRD公式计算。左心室射血分数（EF）为56.9±10.5%。90例（26%）患者出现收缩功能障碍，221例（65%）患者出现二尖瓣反流。GFR范围为19.2至149.7（平均68.8±2.9）ml/min/1.73 m²。114例（34%）患者的慢性肾功能衰竭（CRF）低于60 ml/min/1.73 m²。MR的发生与CHF的功能分级之间存在显著正相关（r = 0.35；p < 0.001），而GFR与MR呈负相关（r = -0.43；p < 0.001）。多因素回归分析表明，无论患者年龄如何，MR的表现均与肾脏功能活动降低有关。得出结论，冠心病和/或动脉高血压所致CHF患者中，二尖瓣回声信号结构变化在GFR低于60 ml/min/1.73 m²的患者中最为常见。MR表现程度与肾脏功能活动受损密切相关。
