Second Department of Internal Medicine, University of Toyama, Toyama, Japan.
Auton Neurosci. 2010 Jun 24;155(1-2):104-8. doi: 10.1016/j.autneu.2010.01.005. Epub 2010 Feb 2.
We investigated whether coexisting renal insufficiency (RI) is associated with elevated sympathetic activity in patients with heart failure (HF). Resting muscle sympathetic nerve activity (MSNA) was determined in 101 patients with HF (ejection fraction<0.45) and 8 patients with RI but without HF (RI group). Diagnosis of RI was made of glomerular filtration rates <60ml/min/1.73m(2) estimated using the simplified Modification of Diet in Renal Disease equation. Of 101 patients, 45 had RI (HFRI group) and 56 did not (HF group). HFRI group was older (p<0.05) and given loop diuretics more frequently (p<0.05), and had a lower specific activity scale (p<0.05) than HF group. HFRI group exhibited significantly greater MSNA indices than either HF group or RI group (burst rate, p<0.05; burst incidence, p<0.01). Univariate analysis showed that RI, age, specific activity scale level and dose of furosemide were significant predictors of increased burst incidence of MSNA in patients with HF. Notably, multivariate analysis revealed that RI was the only independent factor for increased MSNA indices. These findings suggest that coexisting RI is associated with elevated sympathetic activity in patients with HF.
我们研究了心力衰竭（HF）患者并存的肾功能不全（RI）是否与交感神经活性升高有关。在 101 例射血分数<0.45 的 HF 患者（HF 组）和 8 例无 HF 的 RI 患者（RI 组）中测定静息肌肉交感神经活动（MSNA）。RI 的诊断是根据简化肾脏病饮食改良方程估计肾小球滤过率<60ml/min/1.73m²得出的。在 101 例患者中，45 例有 RI（HFRI 组），56 例没有（HF 组）。HFRI 组年龄较大（p<0.05），更频繁使用袢利尿剂（p<0.05），特异性活动量表水平较低（p<0.05）。HFRI 组的 MSNA 指数明显高于 HF 组或 RI 组（爆发率，p<0.05；爆发发生率，p<0.01）。单因素分析显示，RI、年龄、特异性活动量表水平和呋塞米剂量是 HF 患者 MSNA 爆发发生率增加的显著预测因素。值得注意的是，多因素分析显示 RI 是 MSNA 指数增加的唯一独立因素。这些发现表明，HF 患者并存的 RI 与交感神经活性升高有关。
