Adaptive servo-ventilation improves renal function in patients with heart failure
Adaptive servo-ventilation improves renal function in patients with heart failure
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DOI：
10.1016/j.rmed.2011.09.001
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发表时间：
2011-12-01
影响因子：
4.3
通讯作者：
Ito, Hiroshi
中科院分区：
文献类型：
--
作者：
Koyama, Takashi;Watanabe, Hiroyuki;Ito, Hiroshi
背景资料：心脏功能受损和睡眠呼吸障碍（SDB）与心力衰竭（HF）患者的慢性肾病（CKD）进展相关。适应性伺服通气（ASV）治疗通过血流动力学支持和预防重复性低氧应激改善HF患者的心功能，无论SDB的严重程度如何。本研究旨在检验ASV治疗可改善HF患者SDB.Methods肾功能的假设和结果：在59例连续入选的HF患者中，43例中重度SDB患者接受了ASV治疗。HF患者分为ASV治疗组（n = 27）和非ASV治疗组（n = 16）。在开始ASV治疗前和治疗后12个月测量肾小球滤过率（eGFR）、超声心动图参数和炎症生物标志物。在ASV治疗组中发现eGFR改善，但在非ASV治疗组中未发现。eGFR的增加与左室射血分数呈正相关（r = 0.488，p = 0.001）。超敏C反应蛋白（hsCRP）与eGFR呈负相关（r = 0.416，p = 0.006）。结论：ASV治疗可通过血流动力学支持改善HF患者的肾功能。此外，使用ASV治疗预防SDB可以发挥抗炎作用，这可能有助于改善HF患者的肾功能。(C)2011爱思唯尔有限公司版权所有。
Background: Impaired cardiac function and sleep-disordered breathing (SDB) are associated with progression of chronic kidney disease (CKD) in heart failure (HF) patients. Adaptive servo-ventilation (ASV) therapy improves cardiac function in HF patients regardless of the SDB severity through hemodynamic support and prevention of repetitive hypoxic stress. This study was designed to test the hypothesis that ASV therapy improves renal function in HF patients with SDB.Methods and results: Of 59 consecutively enrolled HF patients, 43 with moderate-to-severe SDB underwent ASV therapy. HF patients were divided into the ASV-treated group (n = 27) and the non-ASV-treated group (n = 16). Estimated glomerular filtration rate (eGFR), echocardiographic parameters, and inflammatory biomarkers were measured before and 12 months after ASV initiation. Improvement in the eGFR was found in the ASV-treated group, but not in the non-ASV-treated group. There was a positive correlation between the increases in eGFR and left ventricular ejection fraction (r = 0.488, p = 0.001). The changes in high-sensitivity C-reactive protein were negatively correlated with change in the eGFR (r = 0.416, p = 0.006).Conclusions: ASV therapy could improve renal dysfunction in HF patients through hemodynamic support. Additionally, prevention of SDB with the use of ASV therapy could exert anti-inflammatory effects, which could contribute to the improvement of renal function in HF patients. (C) 2011 Elsevier Ltd. All rights reserved.