Comorbid renal tubular damage and hypoalbuminemia exacerbate cardiac prognosis in patients with chronic heart failure
Comorbid renal tubular damage and hypoalbuminemia exacerbate cardiac prognosis in patients with chronic heart failure
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DOI：
10.1007/s00392-015-0899-z
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发表时间：
2016-02-01
影响因子：
5
通讯作者：
Kubota, Isao
中科院分区：
文献类型：
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作者：
Otaki, Yoichiro;Watanabe, Tetsu;Kubota, Isao
肾小管损伤（RTD）和低蛋白血症是慢性心力衰竭（CHF）患者预后不良的风险。肾小管在氨基酸和白蛋白重吸收中发挥着关键作用，从而维持血清白蛋白水平。本研究的目的是 (1) 检查 RTD 与低白蛋白血症的关联，以及 (2) 评估 CHF 患者共病 RTD 和低白蛋白血症的预后重要性。我们测量了 456 名患者的 N-乙酰基-β-D-葡萄糖酰胺酶 (NAG) 水平和尿 β2-微球蛋白与肌酐比值 (UBCR) 患有CHF的患者。 RTD定义为UBCR a 千分之300μg/g或NAG a 千分之14.2 U/g。 RTD 标记物与血清白蛋白之间存在中等相关性（NAG，r = -0.428，P < 0.0001；UBCR，r = -0.399，P < 0.0001）。多变量logistic分析显示CHF患者RTD与低蛋白血症显着相关。平均 808 天期间发生了 134 起心脏事件。 RTD 和低蛋白血症的合并症随着纽约心脏协会功能分级的提高而增加。多变量 Cox 比例风险回归分析显示 RTD 和低蛋白血症的存在与心脏事件相关。通过将 RTD 和低蛋白血症添加到基本危险因素中，净重分类指数显着改善。常见的 RTD 和低蛋白血症会增加 CHF 患者预后极差的风险。
Renal tubular damage (RTD) and hypoalbuminemia are risks for poor prognosis in patients with chronic heart failure (CHF). Renal tubules play a pivotal role in amino acid and albumin reabsorption, which maintain serum albumin levels. The aims of the present study were to (1) examine the association of RTD with hypoalbuminemia, and (2) assess the prognostic importance of comorbid RTD and hypoalbuminemia in patients with CHF.We measured N-acetyl-beta-D-glucosamidase (NAG) levels and the urinary beta 2-microglobulin to creatinine ratio (UBCR) in 456 patients with CHF. RTD was defined as UBCR a parts per thousand yen300 mu g/g or NAG a parts per thousand yen14.2 U/g. There were moderate correlations between RTD markers and serum albumin (NAG, r = -0.428, P < 0.0001; UBCR, r = -0.399, P < 0.0001). Multivariate logistic analysis showed that RTD was significantly related to hypoalbuminemia in patients with CHF. There were 134 cardiac events during a median period of 808 days. The comorbidity of RTD and hypoalbuminemia was increased with advancing New York Heart Association functional class. Multivariate Cox proportional hazard regression analysis showed that the presence of RTD and hypoalbuminemia was associated with cardiac events. The net reclassification index was significantly improved by adding RTD and hypoalbuminemia to the basic risk factors.Comorbid RTD and hypoalbuminemia are frequently observed and increase the risk for extremely poor outcome in patients with CHF.