社区慢性心力衰竭患者进行蛋白尿测定的临床价值

目的讨论社区慢性心力衰竭(CHF)患者蛋白尿对主要不良心脏事件的影响和分析其与慢性心衰危险因素脑利钠肽(BNP)、C反应蛋白(CRP)之间的关系。方法回顾性病例对照研究。选择60例CHF患者,按照尿蛋白分为蛋白尿无加重组(蛋白尿较前增加2+以下,30例)和蛋白尿加重组(蛋白尿较前增加2+及以上,30例)。根据试纸条法检测的蛋白尿结果判断蛋白尿并分度,免疫荧光法测定BNP、CRP,超声心动图评估心功能。随访比较两组的主要不良心脏事件(MACE)发生率。结果随访12个月后,蛋白尿无加重组与蛋白尿加重组BNP比较有统计学差异(160.1±66.3)ng/L比(209.4±89.5)ng/L,P=0.02],CRP比较有统计学差异(5.7±2.9)mg/L比(8.2±4.5)mg/L,P=0.01],左室射血分数比较有统计学差异(62.5%±6.0%比58.5%±7.0%,P=0.02)。蛋白尿加重组合并糖尿病及冠心病的比例更高(P=0.03和P=0.02),纽约心脏病协会心功能分级高的比例也更大(P=0.04)。两组的MACE发生率有统计学差异(急性心力衰竭和急性冠状动脉综合征的P值分别为0.04和0.01)。在多变量logistic回归模型中,经年龄、合并症、BNP、血红蛋白和估算的肾小球滤过率校正后,蛋白尿仍然是心原性休克(OR=1.98,95%CI:1.21~2.39)及院内死亡(OR=2.56,95%CI:1.65~3.95)的独立危险因素。结论社区CHF患者的蛋白尿和BNP、CRP相关,可能是预测发生MACE的危险因素。

The clinical value of proteinuria measurement for the patients with chronic heart failure in community

Objective To discuss the impact of proteinuria on major adverse cardiac events in the patients with chronic heart failure(CHF)in community and to analyze the relationship among proteinuria and brain natriuretic peptide(BNP)and C-reactive protein(CRP).Methods This was a retrospective case-control study.The clinical data of 60 patients with CHF were analyzed.According to proteinuria compared with before,the patients were divided into non-aggravated proteinuria group(with an increase of<2+,n=30)and aggravated proteinuria group(with an increase of 2+and more,n=30).Proteinuria was determined by the method of the test paper and analyzed by using spectrophotometer and BNP,CRP were determined by immunofluorescence assay.The incidence of major adverse cardiac events(MACE)was compared between groups.Results BNP was a significant difference between proteinuria-aggravated group and non-proteinuria-aggravated group(160.1±66.3)ng/L vs.(209.4±89.5)ng/L,P=0.02].CRP was a significant difference between proteinuria-aggravated group and non-proteinuria-aggravated group(5.7±2.9)mg/L vs.(8.2±4.5)mg/L,P=0.01].Left ventricular ejection fraction was also significant different between proteinuria-aggravated group and non-proteinuria-aggravated group(62.5%±6.0%vs.58.5%±7.0%,P=0.02).Proteinuria-aggravated group was associated with higher rates of diabetes mellitus(P=0.03),coronary heart disease(P=0.02),and worse NYHA class(P=0.04).The incidence of MACE in the two groups was statistically significant(all P<0.05).Multivariate logistic regression showed that proteinuria was an independent risk factor for cardiogenic shock(OR=1.98,95%CI:1.21-2.39)and mortality during hospitalization(OR=2.56,95%CI:1.65-3.95),after adjustment for age,diseases,BNP,hemoglobin and estimated glomerular filtration rat.Conclusions Proteinuria may relate with BNP and CRP in patients with CHF in community,and a risk factor of MACE.