本文選題：慢性心力衰竭　切入點(diǎn)：腎功能不全　出處：《石河子大學(xué)》2017年碩士論文

【摘要】：目的:分析慢性心力衰竭患者合并腎功能不全的臨床特點(diǎn),探討慢性心力衰竭患者伴發(fā)腎功能不全可能的危險(xiǎn)因素。方法:采用回顧性研究的方法,收集整理2014年1月-2016年8月就診于石河子大學(xué)醫(yī)學(xué)院第一附屬醫(yī)院心內(nèi)科符合NYHA心功能Ⅲ~Ⅳ級的慢性心力衰竭患者385例,其中男性211例,女性174例,平均年齡69.62±8.59歲。按照腎小球?yàn)V過率估計(jì)值(e GFR)將入選的慢性心力衰竭患者分為腎功能不全組[e GFR60 m L/(min·1.73 m2)]和非腎功能不全組[e GFR≥60 m L/(min·1.73 m2)],分析比較兩組患者的一般資料、心臟基礎(chǔ)疾病和伴隨疾病、對比劑應(yīng)用史、心臟超聲參數(shù)、腎功能指標(biāo)、血脂、NT-pro BNP、血紅蛋白、尿微量白蛋白等實(shí)驗(yàn)室檢查結(jié)果,Logistic回歸分析慢性心力衰竭患者發(fā)生腎功能不全的獨(dú)立危險(xiǎn)因素。結(jié)果:385例慢性心力衰竭患者中發(fā)生腎功能不全的比例約42.1%。腎功能不全組和非腎功能不全組相比,年齡、NYHA心功能分級、高血壓病史、糖尿病史、合并貧血、合并心房顫動在兩組之間的差異有統(tǒng)計(jì)學(xué)意義(P0.05);腎功能不全組血清肌酐、尿素氮、尿酸、胱抑素C和NT-pro BNP水平以及利尿劑的應(yīng)用比例較非腎功能不全組高;LVEF、血紅蛋白水平及ACEI類藥物的應(yīng)用比例較非腎功能不全組降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。單因素logistic回歸分析顯示,高齡、NYHA心功能Ⅳ級、高血壓病史、糖尿病病史、合并貧血、血清高肌酐水平、高尿素氮水平、高胱抑素C水平、高NT-pro BNP水平以及利尿劑的應(yīng)用為腎功能不全的危險(xiǎn)因素(OR1,P0.05)。多因素Logistic回歸分析顯示,高齡(OR 1.454,95%CI 1.099~1.925)、NYHA心功能IV級(OR 1.940,95%CI 1.142~3.295)、既往高血壓病史(OR 1.617,95%CI 1.009~2.591)、合并貧血(OR 1.903,95%CI 1.151~3.145)、血高尿素氮水平(OR 2.130,95%CI1.266~3.584)、高胱抑素C水平(OR 2.306,95%CI 1.262~4.214)以及利尿劑的使用(OR 2.433,95%CI 1.042~5.679)與腎功能不全的發(fā)生獨(dú)立相關(guān)。結(jié)論:慢性心力衰竭患者中腎功能不全的發(fā)生比例較高,高齡、NYHA心功能Ⅳ級、高血壓病史、合并貧血、高血尿素氮水平、高胱抑素C水平及利尿劑的使用是慢性心力衰竭患者發(fā)生腎功能不全的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective: to analyze the clinical characteristics of the patients with renal insufficiency in patients with chronic heart failure, explore the risk factors of renal dysfunction may be associated with chronic heart failure patients. Methods: a retrospective study method, collected in January 2014 -2016 year in August in the Department of Cardiology of the First Affiliated Hospital of Shihezi University School of medicine in accordance with heart function in patients with chronic heart failure NYHA III ~ IV grade 385 cases, including 211 cases of male, female 174 cases, mean age 69.62 + 8.59 years. According to the estimated glomerular filtration rate (E, GFR) in patients with chronic heart failure were selected and divided into renal insufficiency group [e GFR60 m L/ (min - 1.73 m2)] and non renal dysfunction group [e GFR = 60 m L/ (min - 1.73 m2)], to analyze the general information of the two groups were compared, heart diseases and diseases associated with the history of application, contrast agent, echocardiographic parameters, renal function, blood lipids, hemoglobin, urine NT-pro BNP. The examination results of albumin in laboratory, Logistic regression analysis of independent risk factors of renal dysfunction in patients with chronic heart failure. Results: 385 cases of chronic heart failure in patients with renal insufficiency of 42.1%. renal dysfunction group and non renal insufficiency group than age, NYHA grade of heart function, hypertension the history of diabetes, anemia, fibrillation, differences between the two groups in the atrial was statistically significant (P0.05); renal insufficiency group, serum creatinine, urea nitrogen, uric acid, NT-pro and BNP levels of cystatin C and diuretic agent application compared with non renal insufficiency group; LVEF, the proportion of hemoglobin level and application ACEI drugs than in non renal insufficiency group decreased, the difference was statistically significant (P0.05). Single factor Logistic regression analysis showed that age, NYHA cardiac function grade, disease history, hypertension, history of diabetes, with poor Blood serum creatinine, high level, high urea nitrogen level, the high level of cystatin C, high NT-pro BNP level and the use of diuretics were risk factors of renal dysfunction (OR1, P0.05). Logistic regression analysis showed that age (OR 1.454,95%CI 1.099~1.925), NYHA (OR 1.940,95%CI heart function class IV 1.142~3.295), past history of hypertension (OR 1.617,95%CI 1.009~2.591), anemia (OR 1.903,95%CI 1.151~3.145), blood urea nitrogen level (OR 2.130,95%CI1.266~3.584), the high level of cystatin C (OR 2.306,95%CI 1.262~4.214) and the use of diuretics (OR 2.433,95%CI 1.042~5.679) and the occurrence of renal insufficiency independently. Conclusion: high proportion of kidney. Dysfunction in elderly patients with chronic heart failure, NYHA heart function grade, hypertension, anemia, high blood urea nitrogen level, the use of high levels of cystatin C and chronic diuretic An independent risk factor for renal failure in patients with heart failure.

【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.6;R692

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