高龄老人心力衰竭并肾功能不全93例临床特征分析

【目的】探讨充血性心力衰竭（CHF）合并肾功能不全高龄老人的临床特征。【方法】93例高龄老人CHF根据肾功能指标分为心衰组（A组）51例，心肾1组（B组）15例，心肾2组（C组）27例。对性别、年龄、主要伴发病、治疗有效率及死亡率，治疗前后肌酐（Cr）、尿素氮（BUN）、脑利钠肽（BNP）、血色素（Hb）等资料进行分析。【结果】①B、c组营养不良发生率高于A组（P〈O．001），C组2型糖尿病发生率高于A组（P〈O．05）。②B、C组治疗有效率明显低于A组（P〈0．05）；病死率明显高于A组（P〈0．001）。③治疗后B组Cr显著降低（P〈0．01），与A组接近，BNP仍较A组高（P〈0．05）。治疗后C组Cr、BUN增高（P〈O．01），治疗前后BNP均高于A组（P〈O．05），Hb均低于A组（P〈O．05）。④多元线性回归分析显示心肾综合征的死亡与伴发病营养不良、cr、BUN、BNP、Hb等因素相关；Cr与BNP呈正相关。【结论】①CHF高龄老人有营养不良和2型糖尿病并存时可能更容易发生心肾综合征，且疗效与预后差。②肾功能损害越严重其预后越差，BNP也可能作为判断其预后的一个新指标。

Analysis on the Clinical Characteristics of 93 Aged Patients with Heart Failure and Renal Insufficiency

Objective] To study the clinical characteristics of aged patients with congestive heart failure （CHF） and renal insufficiency. Methods] Ninety three aged patients with heart failure were divided into heart failure group （A group, n = 51）, cardiorenal syndrome group Ⅰ （B group, n = 15） and cardiorenal syndrome group Ⅱ （C group, n =27 ） according to their renal function. The clinical data, such as sex, age, concomitant diseases effective rate, mortality, levels of Bcr, Bun, brain natriuretic peptide （BNP） and Hb before and after treatment of each group were analyzed. Results]（1）The incidence rate of malnutrition in B and C group was higher than that in A group （ P 〈0. 001）. The incidence rate of diabetes type 2 in C group was higher than that in A group （ P 〈0.05）. QThe effective rate in B and C group was lower than that in A group （ P 〈0. 05）. The mortality in B and C group was higher than that in A group （ P〈0. 001）. （3）The Bcr in B group was reduced significantly after treatment（ P 〈0.01）, similar to that in A group, while BNP was still higher（ P〈 0.05）. The Bcr and BUN in C group were increased（ P 〈0.01）, and BNP remained higher（ P〈0.05） after treatment than that in A group. The Hb in C group was lower than that in A group before and after treatment （P 〈0.05）. （4） Multiple linear regression showed that the mortality in cardiorenal syndrome was associated with these factors such as malnutrition, Bcr, Bun, BNP, Hb etc. The Bcr was positive correlation with BNP. Conclusion]（1）Aged patients with heart failure accompanied by malnutrition and diabetes type 2 may be more prone to cardiorenal syndrome with poor efficacy and prognosis. （2）The more serious damage to the kidney, the worse the prognosis was, and the BNP may also be used as a new prognostic indicator.