心力衰竭老年患者肾功能不全的预后指标分析

目的探讨血清胱抑素C(cystatin C,CysC)和氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)及肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素(interleukin,IL)-1β、IL-6、IL-8、IL-23浓度对合并早期肾功能不全老年人心力衰竭预后的影响。方法回顾性分析2014年2月至2016年6月在华北石油管理局总医院心内科住院诊治的老年心力衰竭患者112例的临床资料。根据估计肾小球滤过率(estimated glomerular filtration rate,e GFR)结果将入选患者分为肾功能正常组(n=62)和肾功能不全组(n=60),检测两组患者血清CysC和NT-proBNP及TNF-α、IL-1β、IL-6、IL-8、IL-23的浓度,记录患者主要不良心血管事件(major adverse cardiovascular event,MACE)的发生情况,并进行相关性分析。结果肾功能不全组患者的血清CysC、NT-proBNP、TNF-α、IL-1β、IL-6、IL-8、IL-23浓度显著高于肾功能正常组患者,差异有统计学意义(P<0.05)。肾功能不全组患者的eGFR显著高于肾功能正常组,差异有统计学意义(P<0.05)。两组患者血清尿酸、尿素氮、肌酐及脂蛋白浓度比较,差异无统计学意义(P>0.05)。肾功能不全组患者的恶性心律失常、脑卒中、心源性死亡、再次心力衰竭、再发冠状动脉事件等MACE发生率为5.0%,肾功能正常组为24.2%,两组比较差异有统计学意义(P<0.05)。在肾功能不全组患者中,Spearman检验显示患者MACE的发生与CysC、NT-proBNP、TNF-α、IL-1β、IL-6、IL-8、IL-23都有显著正相关性(P<0.05)。结论NT-proBNP及TNF-α、IL-1β、IL-6、IL-8、IL-23在合并早期肾功能不全老年心力衰竭患者中呈现高表达状况,与患者预后状况显著相关,对肾功能不全合并心力衰竭的临床诊断有重大意义。

Prognostic indicators analysis of renal insufficiency in the elderly patients with heart failure

Objectives To investigate the effect of cystatin C(CysC)and N-terminal pro-brain natriuretic peptide(NT-proBNP),tumor necrosis factor-α(TNF-α),interleukin(IL)-1β,IL-6,IL-8,IL-23 on prognosis of renalfailure in elderly patients with heart failure.MethodsFrom February 2014 to June 2016,112 elderly patients withheart failure were selected in the Department of Cardiology of General Hospital of Huabei Petroleum AdministrationBureau.The clinical data of these patients were retrospectively analized.The patients were divided into normal renalfunction group(n=62)and renal insufficiency group(n=60)according to estimated glomerular filtration rate(e GFR).Serum concentrations of CysC,NT-proBNP,TNF-α,IL-1β,IL-6,IL-8 and IL-23 in the two groups were detected.Major adverse cardiovascular event(MACE)of the two groups were recorded.Correlation analysis was carried out.ResultsSerum concentrations of CysC,NT-proBNP,TNF-α,IL-1β,IL-6,IL-8 and IL-23 in renal insufficiencygroup were significantly higher than those in normal renal function group(P<0.05).eGFR in renal insufficiency groupwas significantly higher than that in normal renal function group(P<0.05).There were no significant differences inserum concentrations of uric acid,urea nitrogen,creatinine and lipoprotein between the two groups(P>0.05).Inci-dence of MACE,such as malignant arrhythmia,stroke,cardiac death,relapse of heart failure and recurrent coronary events in renal insufficiency group was 5%,in normal renal function group was 24.2%,and the difference between thetwo groups was statistically significant(P<0.05).In renal insufficiency group,Spearman test showed that the incidenceof MACE in patients significant positively correlated with CysC,NT-proBNP,TNF-α,IL-1β,IL-6,IL-8 and IL-23(P<0.05).ConclusionsSerum concentrations of CysC,NT-proBNP,TNF-α,IL-1β,IL-6,IL-8 and IL-23 are highin elderly heart failure patients with early renal insufficiency,and they significantly relate to the prognosis of thepatients,which have great significances for the clinical diagnosis of patients with renal failure combined with heart failure.