慢性心力衰竭患者的功能,神经激素激活和生存率
H L Hillege1, A R Girbes, P J de Kam
1Department of Clinical Pharmacology, State University Groningen, The Netherlands.
Circulation
|July 13, 2000
概括
在晚期慢性心力衰竭 (CHF) 中,功能受损是比心脏功能更强烈的死亡预测因素. 这一发现突显了CHF患者脏健康的预后价值.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 内部医学 内部医学
背景情况:
- 慢性心力衰竭 (CHF) 影响功能,并影响心血管和血液动力学特性.
- 评估晚期CHF中功能预后价值对于风险分层至关重要.
- 了解功能和神经激素激活之间的关系对于治疗心血管疾病很重要.
研究的目的:
- 为了确定功能是否预测晚期慢性肺炎的死亡率.
- 将功能预后值与已确定的风险因素进行比较.
- 为了研究功能和神经激素激活在CHF之间的关联.
主要方法:
- 从第二个前性随机化研究Ibopamine的死亡率和有效性中对1906名心血管衰竭患者的分析.
- 使用Cockcroft Gault方程计算基线估计的膜过率 (GFR) (c).
- 在372名患者的亚组中确定血神经激素.
主要成果:
- 估计的膜过率 (GFR) 是死亡率的最强有力的预测因素,超过了纽约心脏协会的类别和血管激素转化酶抑制剂的使用.
- 最低GFR (c) 四分位数 (<44毫升/分) 的患者与最高四分位数 (>76毫升/分) 的患者相比,死亡风险几乎增加了三倍.
- GFR (c) 显示与N端心房尿性 (ANP) 和ANP水平有显著的反相关性,表明神经激素激活高,功能较差.
结论:
- 缺陷功能 (GFR ((c)) 是晚期慢性心力衰竭死亡的一个更重要的预测因素,而不是心脏功能指标,如左心室喷射率 (LVEF) 和纽约心脏协会等级.
- 降低功能与升高的N端ANP水平有关,这表明它在神经激素失调中起作用.
- 缺少功能受损和LVEF之间的相关性表明,除了心脏输出减少之外的因素有助于CHF的功能障碍.
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