腎機能,神経ホルモン活性化,慢性心不全患者の生存率

H L Hillege¹, A R Girbes, P J de Kam

¹Department of Clinical Pharmacology, State University Groningen, The Netherlands.

Circulation

|July 13, 2000

まとめ

進行性慢性心不全 (CHF) の場合,腎機能障害は心臓機能よりも死亡率の強い予測因子である. この発見は,CHF患者の腎臓健康の予後値を強調しています.

科学分野:

心臓病学心臓病学
ネフロロジーはネフロロジーを用います.
内科内科は,内科の内科である.

背景:

腎機能は慢性心不全 (CHF) によって影響を受け,心血管および血液動力学的特性に影響を及ぼします.
進行性CHFにおける腎機能の予後値の評価は,リスクの階層化にとって極めて重要です.
腎機能と神経ホルモンの活性化との関係を理解することは,CHFの管理において重要である.

研究の目的:

腎機能が進行性CHFの死亡率を予測するかどうかを判断する.
既定の危険因子に対する腎機能の予後値を比較する.
CHFにおける腎機能と神経ホルモンの活性化との関連を調査する.

主な方法:

イボパミンの死亡率と有効性に関する第2次前向きランダム化研究から1906人の心臓発作患者の分析.
コッククロフト・ゴールト方程式を用いて,基値推定球フィルタレーション率 (GFR (c)) の計算.
372人の患者のサブグループにおけるプラズマ神経ホルモンの測定.

主要な成果:

推定グルメルーラフィルタレーション率 (GFR (c)) は死亡率の最も強力な予測因子であり,ニューヨーク心臓協会のクラスとアンジオテンシン変換酵素阻害剤の使用を上回った.
最低GFR (<44 mL/min) の四分位数 (c) の患者は,最高四分位数 (>76 mL/min) の患者と比較して,ほぼ3倍の死亡リスクに直面しました.
GFR (c) は,N端の心房内ナトリウレチンペプチド (ANP) とANPレベルとの有意な逆相関を示し,腎機能が低下した神経ホルモンの活性化が高まったことを示した.

結論:

腎機能障害 (GFR ((c)) は,左心室排泄分数 (LVEF) とニューヨーク心臓協会のクラスなどの心機能指標よりも,進行性CHFにおける死亡率の有意な予測因子です.
腎機能の低下は,N-端末のANPレベルが上昇することと関連しており,神経ホルモン不調の役割を示唆しています.
腎機能障害とLVEFの間の相関の欠如は,心電量減少以外の要因がCHFにおける腎機能不全に寄与することを示唆しています.

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