慢性心不全におけるアルブミヌーリア: 罹患率と予後的重要性
Colette E Jackson1, Scott D Solomon, Hertzel C Gerstein
1British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Lancet (London, England)
|August 18, 2009
まとめ
心不全患者の尿アルブミン対クレアチニン比 (UACR) の上昇は,糖尿病や高血圧のない患者でも,不良の結果を予測します. この発見は,心不全の予後のための重要な予後マーカーとしてUACR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.
- クリニカル・メディシン 臨床医学
背景:
- 尿中のアルブミンとクレアチニンの比率 (UACR) の増加によって示されるアルブミヌーリアは,心不全における病理生理学的変化と関連しています.
- UACRの罹患率と予後的重要性を評価することは,心不全の進行を理解するために重要である.
研究 の 目的:
- 心不全患者のUACR増加の罹患率を決定する.
- 心血管疾患のアウトカムとあらゆる原因による死亡率に関するUACRの予後値の評価.
主な方法:
- この研究では,Candesartan in Heart Failure: Assessment of Reduction in Mortality and morbidity (CHARM) プログラムから2310人の患者を対象にUACRを分析した.
- マイクロアルブミヌーリアとマクロアルブミヌーリアの有病率が評価され,UACRの心血管疾患による死亡,心不全による入院,全原因による死亡に関する予測値も評価された.
主要な成果:
- 患者の58%は正常なUACR,30%はマイクロアルブミンウリア,11%はマクロアルブミンウリアでした.
- UACRの上昇は,高齢化,併発性疾患の増加,腎機能の低下,糖尿病の罹患率の増加と関連していました.
- 調整された分析により,UACRの上昇は有害なアウトカムの独立した予測因子として確認され,複合的なアウトカムと死亡に対する危険比は,ノーマルアルブミヌーリアと比較してマイクロアルブミヌーリアとマクロアルブミヌーリア群で著しく高かった.
結論:
- 増加したUACRは,心不全患者の予後を予測する強力で独立した予測因子です.
- UACRの予後値は,糖尿病,高血圧,または腎機能不全のない患者でも持続します.
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