Shi Hong-tao, Wang Xiao-jing, Li Jun, Song Gui-fang, Huang Zhe-yong, Guo Xiang-yu, Guo Jun-jie, Lv Zhi-yang, Li Hong-wei, Ge Jun-bo, Cui Jie, Qi Guan-ming
Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China (H.S., X.W., H.L., G.Q.) Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China (H.S., Z.H., J.G., J.G.).
Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China (H.S., X.W., H.L., G.Q.).
J Am Heart Assoc. 2015 Nov 9;4(11):e002213. doi: 10.1161/JAHA.115.002213.
Several studies have indicated that chronic kidney disease is independently associated with the presence of left ventricular hypertrophy (LVH). However, little clinical data are currently available regarding the detailed correlation between LVH and renal function in elderly patients with non-end-stage renal disease.
A total of 300 in- and outpatients (more than 60 years of age, non-end-stage renal disease), 251 with LVH and 49 without LVH, seen at Beijing Friendship Hospital from January 2000 to December 2010 were included in this retrospective study. One observation period of 12 months was used to detect rapid kidney function decline. The evaluations of cardiac structure and function were performed via echocardiography. The multivariable logistic analysis showed patients with LVH had a much higher risk of rapid kidney function decline than those without LVH. Additionally, the baseline left ventricular mass index was 140 (125-160) g/m(2) in the non-chronic kidney disease group, 152 (130-175) g/m(2) in the mild chronic kidney disease group (estimated glomerular filtration rate (eGFR)≥60 ml/min/1.73 m(2)), and 153 (133-183) g/m(2) in the severe chronic kidney disease group (eGFR<60 ml/min/1.73 m(2)), with a significant difference (P=0.009).
Our data demonstrate that a high rate of renal function decline contributes to pathological LVH in non-end-stage renal disease elderly patients and that LVH is positively associated with renal function decline followed by an increased risk of rapid kidney function decline.
多项研究表明，慢性肾脏病与左心室肥厚（LVH）的存在独立相关。然而，目前关于非终末期肾病老年患者LVH与肾功能之间详细相关性的临床数据较少。
本回顾性研究纳入了2000年1月至2010年12月在北京友谊医院就诊的300例门诊和住院患者（年龄超过60岁，非终末期肾病），其中251例有LVH，49例无LVH。采用12个月的观察期来检测肾功能快速下降情况。通过超声心动图对心脏结构和功能进行评估。多变量逻辑分析显示，有LVH的患者肾功能快速下降的风险比无LVH的患者高得多。此外，非慢性肾脏病组的基线左心室质量指数为140（125 - 160）g/m²，轻度慢性肾脏病组（估计肾小球滤过率（eGFR）≥60 ml/min/1.73 m²）为152（130 - 175）g/m²，重度慢性肾脏病组（eGFR<60 ml/min/1.73 m²）为153（133 - 183）g/m²，差异有统计学意义（P = 0.009）。
我们的数据表明，肾功能快速下降率导致非终末期肾病老年患者出现病理性LVH，且LVH与肾功能下降呈正相关，进而导致肾功能快速下降风险增加。
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