舒张功能不全患者心脏结构改变与肾功能的关系

目的 探究单纯舒张性心力衰竭患者心脏结构改变与肾功能的关系。方法 采用回顾性分析法收集并分析2015~2016年上海第九人民医院心内科收治的262例舒张性心力衰竭患者的临床资料。统计方法采用t检验，χ²检验，Pearson相关分析与线性回归分析等方法对相关资料进行分析。结果 舒张性心力衰竭合并肾功能不全组较肾功能正常组，左心房增大（90.8% vs 78.0%，P=0.008），左心室增厚（50.0% vs 35.2%，P=0.018）。血肌酐水平与舒张期后壁厚度（PWT）呈正相关（r=0.007，P=0.011），与舒张期末室间隔厚度（IVST）呈正相关（r=0.007，P=0.042），与左心室舒张末内径（LVEDD）呈正相关（r=0.023，P=0.039），与左心房内径（LA）呈正相关（r=0.051，P<0.01）。亚组分析80岁以上和病程在1年以上舒张性心力衰竭患者，其更容易发生肾功能不全；心力衰竭级别越高者肾功能越差，心脏结构改变越明显。结论 单纯舒张性心力衰竭患者的左心房增大及左心室增厚与肾功能降低相关，改善肾功能可望延缓或逆转舒张性心力衰竭患者的心房、心室重构，从而抑制心力衰竭发展。

Correlation between Renal Function and Cardiac Structure Remodeling in Patients with Diastolic Heart Failure

Objective To explore the role of kidneys in the changes of cardiac structural for the patients with diastolic heart failure. Methods We used retrospective investigation method to analyze the 262 diastolic heart failure patients during September 2015 to September 2016, treated in Department of Cardiology of Shanghai No.9 People''s Hospital.The statistical methods that T Test,Chi Square Test,Pearson correlation analysis and linear regression analysis were involved. Results Compared with normal renal function group, it was that left atrial enlargement (90.8% vs 78.0%, P=0.008) and left ventricular thickening (50.0% vs 35.2%, P=0.018) in diastolic heart failure with renal insufficiency group.Serum creatinine level was positively correlated with diastolic posterior wall thickness (PWT) (r=0.007,P=0.011), end diastolic ventricular septal thickness (IVST) (r=0.007, P=0.042),left ventricular end diastolic diameter (LVEDD) (r=0.023,P=0.039) and left atrium diameter (LA) (r=0.051,P<0.01).Under subgroup analysis,renal dysfunction was more common in patients over 80 years of age and more than one year duration in diastolic heart failure.The higher level of heart failure made,the worse renal function played,and the more obvious change of cardiac structure was. Conclusion Left atrial enlargement and left ventricular thickening are associated with the decreases in renal function of patients with diastolic heart failure.It''s expected to delay or reverse atrial ventricular remodeling in patients with diastolic heart failure by improving renal function, thus inhibiting the development of heart failure.