心力衰竭患者射血分数降低与射血分数保留的尿标志物谱。
Urinary Marker Profiles in Heart Failure with Reduced Versus Preserved Ejection Fraction.
机构信息
Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
University of Bergen, 5007, Bergen, Norway.
出版信息
J Cardiovasc Transl Res. 2024 Feb;17(1):3-12. doi: 10.1007/s12265-023-10356-y. Epub 2023 Feb 16.
BACKGROUND
Recent data suggest different causes of renal dysfunction between heart failure with reduced (HFrEF) versus preserved ejection fraction (HFpEF). We therefore studied a wide range of urinary markers reflecting different nephron segments in heart failure patients.
METHODS
In 2070, in chronic heart failure patients, we measured several established and upcoming urinary markers reflecting different nephron segments.
RESULTS
Mean age was 70 ± 12 years, 74% was male and 81% (n = 1677) had HFrEF. Mean estimated glomerular filtration rate (eGFR) was lower in patients with HFpEF (56 ± 23 versus 63 ± 23 ml/min/1.73 m, P = 0.001). Patients with HFpEF had significantly higher values of NGAL (58.1 [24.0-124.8] versus 28.1 [14.6-66.9] μg/gCr, P < 0.001) and KIM-1 (2.28 [1.49-4.37] versus 1.79 [0.85-3.49] μg/gCr, P = 0.001). These differences were more pronounced in patients with an eGFR > 60 ml/min/1.73m.
CONCLUSIONS
HFpEF patients showed more evidence of tubular damage and/or dysfunction compared with HFrEF patients, in particular when glomerular function was preserved.
背景
最近的数据表明，射血分数降低的心力衰竭（HFrEF）与射血分数保留的心力衰竭（HFpEF）患者的肾功能障碍原因不同。因此，我们研究了一系列反映心力衰竭患者不同肾单位的广泛的尿标志物。
方法
在 2070 例慢性心力衰竭患者中，我们测量了几种反映不同肾单位的已建立和新兴的尿标志物。
结果
患者平均年龄为 70±12 岁，74%为男性，81%（n=1677）为 HFrEF。HFpEF 患者的估算肾小球滤过率（eGFR）明显更低（56±23 与 63±23 ml/min/1.73 m，P=0.001）。HFpEF 患者的 NGAL（58.1[24.0-124.8]与 28.1[14.6-66.9]μg/gCr，P<0.001）和 KIM-1（2.28[1.49-4.37]与 1.79[0.85-3.49]μg/gCr，P=0.001）值明显更高。在 eGFR>60 ml/min/1.73m 的患者中，这些差异更为明显。
结论
与 HFrEF 患者相比，HFpEF 患者表现出更多的肾小管损伤和/或功能障碍的证据，特别是当肾小球功能保留时。
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