运动后心率恢复和代谢综合征在 IgA 肾病中的预后作用。

The prognostic role of heart rate recovery after exercise and metabolic syndrome in IgA nephropathy.

机构信息

2nd Department of Internal Medicine and Nephrology, Diabetology Center, University of Pécs, Clinical Center Medical School, Pacsirta street 1, Pécs, 7624, Hungary.

Fresenius Medical Care Dialysis Center Pécs, Pécs, Hungary.

出版信息

BMC Nephrol. 2021 Nov 23;22(1):390. doi: 10.1186/s12882-021-02596-4.

DOI:10.1186/s12882-021-02596-4

PMID:34809611

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8609750/

Abstract

BACKGROUND

Cardiovascular (CV) morbidity and mortality are higher in chronic kidney disease (CKD) than in the general population. Reduced heart rate recovery (HRR) is an independent risk factor for CV disease. The aim of the study was to determine the prognostic role of HRR in a homogenous group of CKD patients.

METHODS

One hundred and twenty-five IgA nephropathy patients (82 male, 43 female, age 54.7 ± 13 years) with CKD stage 1-4 were investigated and followed for average 70 months. We performed a graded exercise treadmill stress test. HRR was derived from the difference of the peak heart rate and the heart rate at 1 min after exercise. Patients were divided into two groups by the mean HRR value (22.9 beats/min). The composite (CV and renal) endpoints included all-cause mortality and any CV event such as stroke, myocardial infarction, revascularisation (CV) and end-stage renal disease, renal replacement therapy (renal).

RESULTS

Patients with reduced HRR (< 23 bpm) had significantly more end point events (22/62 patients vs. 9/53 patients, p = 0.013) compared to the higher HRR (≥23 bpm). Of the secondary the endpoints (CV or renal separately) rate of the renal endpoint was significantly higher in the lower HRR group (p = 0.029), while there was no significant difference in the CV endpoint between the two HRR groups (p = 0.285). Independent predictors of survival were eGFR and diabetes mellitus by using Cox regression analysis. Kaplan-Meier curves showed significant differences in metabolic syndrome and non-metabolic syndrome when examined at the combined endpoints (cardiovascular and renal) or at each endpoint separately. The primary endpoint rate was increased significantly with the increased number of metabolic syndrome component (Met.sy. comp. 0 vs. Met. sy. comp. 2+, primary endpoints, p = 0.012).

CONCLUSION

Our results showed that reduced HRR measured by treadmill exercise test has a predictive value for the prognosis of IgA nephropathy. The presence of metabolic syndrome may worsen the prognosis of IgA nephropathy.

摘要

背景

心血管疾病发病率和死亡率在慢性肾脏病（CKD）患者中高于普通人群。心率恢复减少（HRR）是心血管疾病的独立危险因素。本研究的目的是确定 HRR 在同质 CKD 患者群体中的预后作用。

方法

研究纳入 125 例 IgA 肾病患者（82 名男性，43 名女性，年龄 54.7±13 岁），CKD 分期 1-4 期，平均随访 70 个月。我们进行了分级运动平板运动试验。HRR 是通过运动后 1 分钟时的峰值心率与心率之间的差异得出的。根据平均 HRR 值（22.9 次/分钟）将患者分为两组。复合（心血管和肾脏）终点包括全因死亡率和任何心血管事件（如中风、心肌梗死、血运重建[心血管]和终末期肾病、肾脏替代治疗[肾脏]）。

结果

HRR 降低（<23 次/分钟）的患者终点事件显著更多（22/62 例患者 vs. 9/53 例患者，p=0.013），与 HRR 较高（≥23 次/分钟）的患者相比。在次要终点（心血管或肾脏单独）中，较低 HRR 组的肾脏终点发生率显著较高（p=0.029），而两组之间心血管终点无显著差异（p=0.285）。Cox 回归分析显示，生存的独立预测因素是 eGFR 和糖尿病。Kaplan-Meier 曲线显示，在复合终点（心血管和肾脏）或每个终点分别检查时，代谢综合征和非代谢综合征之间存在显著差异。主要终点发生率随着代谢综合征成分数量的增加而显著增加（Met.sy. comp. 0 与 Met. sy. comp. 2+，主要终点，p=0.012）。