Otaki Yoichiro, Watanabe Tetsu, Takahashi Hiroki, Narumi Taro, Kadowaki Shinpei, Honda Yuki, Arimoto Takanori, Shishido Tetsuro, Miyamoto Takuya, Konta Tsuneo, Kubota Isao
Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan.
Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan.
Int J Cardiol. 2014 May 1;173(2):222-8. doi: 10.1016/j.ijcard.2014.02.044. Epub 2014 Feb 28.
Cardio-renal anemia syndrome (CRAS) has begun to gather attention as a vicious circle since chronic heart failure (CHF), chronic kidney disease (CKD), and anemia are all able to be caused and exacerbated by each other. However, it remains unclear whether renal tubular damage (RTD), another type of kidney dysfunction, is associated with this vicious circle. The aim of the present study was to assess the association of RTD with CRAS in patients with CHF.
We included 300 consecutive patients with CHF. RTD was defined as a urinary β2-microglobulin to creatinine ratio ≥ 300 μg/g. Patients with RTD had lower serum iron and higher levels of high sensitivity C-reactive protein than those without it. Multivariate logistic analysis showed that RTD was closely associated with anemia in patients with CHF, after adjustment for confounding factors. During a median period of 1,098 days, there were 86 cardiac events, including 14 cardiac deaths and 72 re-hospitalizations for worsening heart failure. Net reclassification improvement was significantly improved by addition of RTD to the model including age, New York Heart Association functional class, brain natriuretic peptide, anemia, and CKD. All patients were divided into 3 groups: CRAS+RTD group, CRAS group, and control group. Kaplan-Meier analysis demonstrated that CRAS+RTD had the greatest risk in patients with CHF.
RTD was associated with normocytic anemia, accompanying iron deficiency and inflammation. RTD added prognostic information to conventional CRAS, suggesting the importance of RTD in cardio-renal anemia interaction.
由于慢性心力衰竭（CHF）、慢性肾脏病（CKD）和贫血能够相互引发并加重病情，心肾贫血综合征（CRAS）已开始作为一个恶性循环而受到关注。然而，另一种类型的肾功能障碍——肾小管损伤（RTD）是否与这个恶性循环相关仍不清楚。本研究的目的是评估CHF患者中RTD与CRAS的关联。
我们纳入了300例连续的CHF患者。RTD定义为尿β2-微球蛋白与肌酐比值≥300μg/g。与无RTD的患者相比，有RTD的患者血清铁水平较低，高敏C反应蛋白水平较高。多因素logistic分析显示，在调整混杂因素后，CHF患者中RTD与贫血密切相关。在中位时间1098天内，发生了86次心脏事件，包括14例心源性死亡和72例因心力衰竭恶化再次住院。在包含年龄、纽约心脏协会心功能分级、脑钠肽、贫血和CKD的模型中加入RTD后，净重新分类改善显著提高。所有患者分为3组：CRAS+RTD组、CRAS组和对照组。Kaplan-Meier分析表明，CRAS+RTD组在CHF患者中风险最大。
RTD与正细胞性贫血相关，伴有缺铁和炎症。RTD为传统的CRAS增加了预后信息，提示RTD在心肾贫血相互作用中的重要性。
