| 黄厚源,彭旭东,车贺宾,等.药物治疗对急性失代偿心力衰竭患者发生院内肾功能恶化的影响[J].中国临床保健杂志,2025,28(4):493-499. |
| 药物治疗对急性失代偿心力衰竭患者发生院内肾功能恶化的影响 |
| The effect of drug therapy on in-hospital renal function deterioration in patients with acute decompensated heart failure |
| 投稿时间：2025-05-17 |
| DOI：10.3969/J.issn.1672-6790.2025.04.012 |
| 中文关键词: 心力衰竭 肾功能不全 肾上腺素能激动剂 药物疗法 影响因素分析 |
| 英文关键词: Heart failure Renal insufficiency Adrenergic agonists Drug therapy Root cause analysis |
| 基金项目:军队后勤科研项目(20BJZ47) |
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| 中文摘要: |
| 目的 探讨药物治疗对急性失代偿心力衰竭(ADHF)患者发生院内肾功能恶化(WRF)的影响。方法 回顾性研究中国人民解放军总医院2009年1月至2019年1月连续收治ADHF患者的临床资料、入院情况、在院用药等指标,以院内WRF为主要终点事件。根据患者肾功能变化情况分为WRF组和非WRF组,对比2组患者在入院时的基线资料和药物使用情况,使用单因素和多因素分析筛选出可能导致ADHF患者发生WRF的药物及危险因素。结果 纳入1 199例ADHF患者,WRF组320例,非WRF组879例；WRF组患者年龄[75.0(61.0,83.0)岁]大于非WRF组[69.0(56.0,80.0)岁],P＜0.05；慢性肾脏病患者(Ⅰ~Ⅳ期)比例[105例(32.81%)]高于非WRF组[165例(18.77%)],P＜0.05；血清尿酸[343.250(266.500,441.350)μmol/L]和血清白蛋白水平[37.500(34.200,40.500)g/L]低于非WRF组患者[408.400(312.000,516.950)μmol/L,38.400(34.800,41.500)g/L],均P＜0.05；使用肾上腺素受体激动剂患者比例[100例(32.25%)]高于非WRF组[178例(20.25%)],P<0.05。多因素logistic回归分析发现,使用肾上腺素受体激动剂是ADHF患者发生院内WRF的独立危险因素。结论 肾上腺素受体激动剂可能增加ADHF患者发生院内WRF风险,尤其是对高龄、慢性肾脏病(Ⅰ~Ⅳ期)患者。 |
| 英文摘要: |
| Objective To investigate the impact of drug treatment regimens on the risk of in-hospital worsening renal function (WRF) in patients with acute decompensated heart failure (ADHF),and evaluate the predictive efficacy of drug treatment regimen selection combined with traditional clinical indicators for in-hospital WRF.Methods This retrospective cohort study analyzed the clinical data of consecutively enrolled ADHF patients at the General Hospital of the Chinese PLA from January 2009 to January 2019.Data included baseline demographics,admission characteristics,in-hospital medications,and laboratory parameters.The primary endpoint was in-hospital WRF.Patients were stratified into a WRF group and a control group based on renal function changes.Baseline characteristics and medication usage upon admission were compared between groups.Univariate and multivariate analyses were employed to identify medications,as well as risk and protective factors,associated with WRF development in ADHF patients.Results A total of 1 199 ADHF patients were included:320 in the WRF group and 879 in the control group.The WRF group comprised 192 males,compared to 588 males in the control group.The mean age in the WRF group [75.0(61.0,83.0)years] was significantly higher than in the control group [69.0(56.0,80.0)years],P<0.05.The proportion of patients with chronic kidney disease (stage Ⅰ-Ⅳ) was significantly higher in the WRF group (105 patients,32.81%) than that in the control group (165 patients, 18.77%;P<0.05). Serum uric acid levels [343.250 (266.500,441.350)μmol/L] and serum albumin levels [37.500 (34.200,40.500)g/L] were significantly lower in the WRF group compared to the control group [408.400(312.000,516.950)μmol/L,38.400(34.800,41.500)g/L](P<0.05).The proportion of patients receiving adrenergic receptor agonists was significantly higher in the WRF group (100 patients,32.25%) than in the control group (178 patients,20.25%),P<0.05.Multivariate logistic regression analysis identified the use of adrenergic receptor agonists as an independent risk factor for in-hospital WRF in ADHF patients.Conclusions Adrenergic receptor agonists may increase the risk of in-hospital WRF in ADHF patients,particularly among the elderly with chronic kidney disease(stage Ⅰ-Ⅳ). |
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