心力衰竭患者血脂谱与肾功能不全之间的关联

Association Between the Lipid Profile and Renal Dysfunction in the Heart Failure Patients.

作者信息

Zhang Hong, Shi Shuang, Zhao Xiu-Juan, Wang Jun-Kui, Liu Zhong-Wei, Liu Fu-Qiang, Zhu Ling, Zhu Shun-Ming, Zhang Yong, Pan Shuo

机构信息

Department of Neurology, People's Hospital of Shaanxi Province, Xi'an, China.

First Department of Cardiology, People's Hospital of Shaanxi Province, Xi'an, China.

出版信息

Kidney Blood Press Res. 2019;44(1):52-61. doi: 10.1159/000498834. Epub 2019 Feb 22.

DOI:10.1159/000498834

PMID:30808836

Abstract

BACKGROUND/AIMS: In heart failure patients with high prevalence of chronic renal disease (CKD), hospitalization and mortality, whether the lipid profile was associated with renal dysfunction remained unknown. The present study intended to clarify the association between the lipid profile and renal dysfunction in the heart failure patients.

METHODS

336 hospitalized heart failure patients with left ventricle ejection fraction (LVEF) ≤45% and New York Heart Association (NYHA) class II-IV were enrolled. The estimated glomerular filtration rate (eGFR) < 90 mL/min·1.73 m2 was defined as renal dysfunction. The demographic, clinical data, blood samples and echocardiography were documented. The Pearson simple linear correlation was performed to evaluate the confounding factors correlated with eGFR. The significantly correlated factors were enrolled in Logistic regression as confounding factors to determine the association between the lipid profile and renal dysfunction in the heart failure patients.

RESULTS

182 patients (54.2%) had renal dysfunction and 154 patients (45.8%) did not have renal dysfunction. The waist circumference, platelet counts, platelet distribution width (PDW), high density lipoprotein-cholesterol (HDL-C), apolipoprotein A1 (apoA1), albumin and left ventricular ejection fraction (LVEF) are positively correlated with eGFR (all P< 0.05). Meanwhile, the age, mean platelet volume (MPV), neutrophilic granulocyte percentage (NEUT%), urea nitrogen (BUN), creatinine and total bilirubin (TBIL) are negatively correlated with eGFR (all P< 0.05). The total cholesterol (TC), triglyceride, low density lipoprotein-cholesterol (LDL-C) and apolipoprotein B (apoB) show no correlation with eGFR. After the adjustment of sex, hypertension, diabetes mellitus, age, waist circumference, platelet counts, MPV, PDW, NEUT%, TBIL, albumin and LVEF, HDL-C is the only lipid factor still significantly associated with renal dysfunction in hospitalized heart failure patients (OR=0.119, P=0.003).

CONCLUSION

Among the lipid profile of TC, triglyceride, LDL-C, HDL-C, apo A1 and apo B, the HDL-C is the only lipid factor significantly associated with renal dysfunction in hospitalized heart failure patients.

摘要

背景/目的：在慢性肾病（CKD）患病率较高的心力衰竭患者中，住院率和死亡率较高，而血脂谱是否与肾功能不全相关尚不清楚。本研究旨在阐明心力衰竭患者血脂谱与肾功能不全之间的关联。

方法

纳入336例住院的左心室射血分数（LVEF）≤45%且纽约心脏协会（NYHA）心功能分级为II-IV级的心力衰竭患者。估算肾小球滤过率（eGFR）<90 mL/min·1.73 m2被定义为肾功能不全。记录人口统计学、临床数据、血样和超声心动图检查结果。采用Pearson简单线性相关分析评估与eGFR相关的混杂因素。将显著相关因素纳入Logistic回归作为混杂因素，以确定心力衰竭患者血脂谱与肾功能不全之间的关联。

结果

182例患者（54.2%）存在肾功能不全，154例患者（45.8%）不存在肾功能不全。腰围、血小板计数、血小板分布宽度（PDW）、高密度脂蛋白胆固醇（HDL-C）、载脂蛋白A1（apoA1）、白蛋白和左心室射血分数（LVEF）与eGFR呈正相关（均P<0.05）。同时，年龄、平均血小板体积（MPV）、中性粒细胞百分比（NEUT%）、尿素氮（BUN）、肌酐和总胆红素（TBIL）与eGFR呈负相关（均P<0.05）。总胆固醇（TC）、甘油三酯、低密度脂蛋白胆固醇（LDL-C）和载脂蛋白B（apoB）与eGFR无相关性。在调整性别、高血压、糖尿病、年龄、腰围、血小板计数、MPV、PDW、NEUT%、TBIL、白蛋白和LVEF后，HDL-C是唯一仍与住院心力衰竭患者肾功能不全显著相关的血脂因素（OR=0.119，P=0.003）。