脑利钠肽介导了肌酐清除率对急性冠状动脉综合征患者左心室收缩功能障碍发展的影响。

Brain natriuretic peptide mediates the effect of creatinine clearance on development of left ventricular systolic dysfunction in patients with acute coronary syndrome.

机构信息

First Cardiology Department, University of Athens Medical School, Hippokration Hospital, Athens, Greece.

出版信息

Hellenic J Cardiol. 2010 Sep-Oct;51(5):413-20.

PMID:20876054

Abstract

INTRODUCTION

There are only limited data about the role of renal function in the development of left ventricular systolic dysfunction in patients with an acute coronary syndrome (ACS). We sought to investigate whether renal insufficiency is an independent predictor for systolic dysfunction among patients who had an ACS.

METHODS

During 2006-2007, 814 consecutive patients who presented with an ACS event were enrolled prospectively; of these, 284 men (65 ± 14 years) and 71 women (71 ± 12 years) developed left ventricular systolic dysfunction (ejection fraction <40%), 306 men (64 ± 12 years) and 78 women (67 ± 10 years) had preserved left ventricular systolic function (ejection fraction >50%), while the rest of the patients (n=75), with ejection fraction between 40-50%, were excluded from this analysis. Creatinine clearance rates were estimated by the Cockcroft-Gault formula.

RESULTS

Eight percent of patients presented with severe and 30% with moderate renal dysfunction. Multiple logistic regression analysis revealed that a 10-unit increase of creatinine clearance levels decreases the odds of developing left ventricular systolic dysfunction by 8% (95%CI per 1 unit: 0.986-0.998), after controlling for potential confounders. Moreover, brain natriuretic peptide levels were inversely correlated with creatinine clearance (r=-0.378, p<0.001). When brain natriuretic peptide was entered into the model, creatinine clearance was not associated with left ventricular systolic dysfunction (OR=0.997, 95%CI 0.989-1.005).

CONCLUSIONS

The role of renal insufficiency in the development of left ventricular systolic dysfunction seems to be partially explained by plasma brain natriuretic peptide levels, suggesting a potential pathophysiological mechanism. Thus, patients with impaired creatinine levels and elevated brain natriuretic peptide levels should receive more aggressive medical care, as they are prone to developing left ventricular systolic dysfunction.

摘要

简介

关于肾功能在急性冠状动脉综合征（ACS）患者左心室收缩功能障碍发展中的作用，仅有有限的数据。我们试图研究肾功能不全是否是 ACS 患者收缩功能障碍的独立预测因子。

方法

在 2006-2007 年期间，前瞻性地纳入了 814 例连续出现 ACS 事件的患者；其中，284 名男性（65±14 岁）和 71 名女性（71±12 岁）出现左心室收缩功能障碍（射血分数<40%），306 名男性（64±12 岁）和 78 名女性（67±10 岁）保留了左心室收缩功能（射血分数>50%），其余患者（n=75）射血分数在 40-50%之间，被排除在本分析之外。肌酐清除率通过 Cockcroft-Gault 公式估计。

结果

8%的患者表现为严重肾功能不全，30%的患者表现为中度肾功能不全。多变量逻辑回归分析显示，肌酐清除率每增加 10 个单位，左心室收缩功能障碍的发生几率降低 8%（95%CI 每单位：0.986-0.998），在控制了潜在的混杂因素后。此外，脑钠肽水平与肌酐清除率呈负相关（r=-0.378，p<0.001）。当脑钠肽被纳入模型时，肌酐清除率与左心室收缩功能障碍无关（OR=0.997，95%CI 0.989-1.005）。