Yang Yan-hua, Wang Lin, An Fang, Huang Jiao-hong, Ma Jin-ping, Li Guang-ping, Li Li-feng
Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2009 Aug;37(8):729-33.
To analyze the impact of renal dysfunction on survival in hospitalized chronic heart failure (CHF) patients.
In this retrospective analysis, we collected all clinical data from eligible patients hospitalized in the second hospital of Tianjin Medical University between Jan 1980 and Aug 2007. CHF patients were divided into three groups according to glomerular filtration rate (GFR): A, normal renal function; B, mild renal dysfunction; C, renal dysfunction. Patients in group C were further divided into three subgroups according to hospitalization year: D, 1980.01 - 1989.12; E, 1990.01 - 1999.12; F, 2000.01 - 2007.08.
Renal dysfunction was found in 714 patients. Compared with group A (n = 817) and group B (n = 928), patients in group C were older, had worse heart function and major medications included nitrates, diuretics and digitalis. From 1980 to 2007, use of Angiotensin II receptor antagonist, beta-blocker, statins significantly increased and the in-hospital mortality significantly decreased in group C patients. Percent of angiotensin converting enzyme inhibitor (ACEI) use was the highest in 1990s. The hospital stay was significantly longer and all cause in-hospital mortality was significantly higher in group C compared to group A and group B (all P < 0.01). After adjustment for other risk factors by multivariate analysis, renal dysfunction was an independent risk factor of in-hospital all cause mortality. Patients faced 16.7% higher risk of all cause in-hospital mortality for every 10 mlxmin(-1) x1.73 m(-2) decrease in GFR.
The incidence of renal dysfunction was high in CHF patients. The hospital stay was longer, in-hospital all-cause mortality was higher in CHF patients with renal dysfunction compared to CHF patients without or with mild renal dysfunction. Renal dysfunction was an independent risk factor for all-cause in-hospital mortality. Increased use of ACEI, ARB, beta-blocker and statins might be responsible for reduced in-hospital mortality in CHF with renal dysfunction patients in recent years.
分析肾功能不全对住院慢性心力衰竭（CHF）患者生存的影响。
在这项回顾性分析中，我们收集了1980年1月至2007年8月期间在天津医科大学第二医院住院的符合条件患者的所有临床数据。CHF患者根据肾小球滤过率（GFR）分为三组：A组，肾功能正常；B组，轻度肾功能不全；C组，肾功能不全。C组患者根据住院年份进一步分为三个亚组：D组，1980.01 - 1989.12；E组，1990.01 - 1999.12；F组，2000.01 - 2007.08。
共发现714例患者存在肾功能不全。与A组（n = 817）和B组（n = 928）相比，C组患者年龄更大，心功能更差，主要用药包括硝酸盐、利尿剂和洋地黄。从1980年到2007年，C组患者使用血管紧张素II受体拮抗剂、β受体阻滞剂、他汀类药物的比例显著增加，住院死亡率显著降低。血管紧张素转换酶抑制剂（ACEI）的使用比例在20世纪90年代最高。与A组和B组相比，C组患者的住院时间显著更长，全因住院死亡率显著更高（均P < 0.01）。多因素分析调整其他危险因素后，肾功能不全是住院全因死亡率的独立危险因素。GFR每降低10 ml·min⁻¹·1.73 m⁻²，患者全因住院死亡风险增加16.7%。
CHF患者肾功能不全的发生率较高。与无肾功能不全或轻度肾功能不全的CHF患者相比，肾功能不全的CHF患者住院时间更长，住院全因死亡率更高。肾功能不全是住院全因死亡率的独立危险因素。近年来，ACEI、ARB、β受体阻滞剂和他汀类药物使用的增加可能是肾功能不全CHF患者住院死亡率降低的原因。
