袢利尿剂对慢性心力衰竭患者肾功能的影响

目的 探讨袢利尿剂对慢性心力衰竭患者肾功能的影响.方法 采用病例对照研究方法,分析袢利尿剂应用与肾功能恶化发生有无统计学关联,是否为其发生的独立危险因素.以住院期间任何时间出现的肌酐值较入院时升高≥26.5 μmol/L作为肾功能恶化的标准,分为病例组(肌酐≥26.5umol/L,66例)及对照组(肌酐＜26.5 μmol/L,145例).结果 病例组袢利尿剂总剂量(385.17±49.37)mg明显大于对照组(244.50±34.82)mg(P ＜0.05),但利尿剂量与肾功能恶化的发生无独立相关性(P＞0.05),入院肌酐浓度及心功能分级与肾功能恶化的发生独立相关,OR值分别为2.248(95％CI:1.088 ～4.647)和2.485(95％ CI:1.385～4.459)(P均＜0.05).结论 袢利尿剂应用与肾功能恶化的发生无独立相关性,入院肌酐浓度偏高及心功能差为心力衰竭患者住院期间发生肾功能恶化的独立危险因素.

Effects of loop diuretic on renal function in patients with chronic heart failure

Objective To describe the effect of loop diuretic on renal function in patients with chronic heart failure.Methods Data were of 211 impatients diagnosed as HF collected in a nested case-control study.The association of application of loop diuretic with renal function was assessed to identify whether loop diuretic was an independent risk factor of worsening renal function(WRF).To identify WRF,we defined serum creatinine level as a rise ≥26.5 μmol/L compared to the level at admission.Therefore,the subjects were divided into case group(serum creatinine level ≥ 26.5 μmol/L,n =66)and control group(serum creatinine level ＜ 26.5μmol/L,n =145).Results The doses of loop diuretic were higher in the case group(385.17 ± 49.37]mg)than the control group(244.50 ± 34.82]ag)(P ＜ 0.05),but it was not independent risk factor of WRF (P＞0.05).Creatinine level and NYHA class at admission were independent risk factor for WRF,with OR of 2.248(95 ％ CI:1.088-4.647)and 2.485(95 ％ CI:1.385-4.459)respectively(Ps ＜ 0.05).Conclusion The doses ofloop diuretic were not independent risk factor of WRF,creatinine level and severity of HF at admission are the most important predictors of the occurrence of WRF.