老年糖尿病患者急性心衰的肾功能变化特点及预后.DOC

老年糖尿病患者急性心衰时急性肾损伤发生及预后分析 翟文亮 王荣欣 李俊芬 王晶 (首都医科大学宣武医院 急诊科 北京 100053) 【摘要】　目的　分析老年糖尿病合并急性心衰患者急性肾损伤（acute kidney injury，AKI）发生情况及短期预后。方法 107例老年糖尿病合并急性心衰患者作为观察组, 同期老年非糖尿病合并急性心衰患者79例作为对照组,采集两组患者一般情况、病史、血尿素氮、肌酐、左室射血分数、血浆NT-proBNP等指标，观察两组患者住院期间AKI发生情况，院内死亡情况和平均住院时间。6个月时随访心血管事件发生率及死亡情况。按院内是否发生AKI进行组内对比，了解亚组间死亡率的差异。结果　观察组患者的AKI发生率、平均住院时间及院内死亡率高于对照组 (P0.05)；观察组患者60天心血管事件发生率高于对照组差异(P0.05)；发生院内AKI的患者死亡率明显升高(P0.05)。结论　合并糖尿病的老年急性心衰患者AKI发生率高，院内死亡率高，院外心血管事件发生率高，并且发生AKI的患者死亡率更高。 【关键词】 急性肾损伤;急性心衰;糖尿病;老年 Morbility and Prognosis of Acute Kidney Injury on Aged Diabetes with Acute Heart Failure Zhai Wenliang, Wang Rongxin, Li Junfen, Wang Jing （Emergency Department of Xuanwu Hospital of Capital Medical University,Beijing,100053 ） Abstract Objective To analysis the morbidity rate of acute kidney injury(AKI) in acute heart failure of the aged diabetes（DM）, and follow up at 6 month. Method 186 aged patients were under research. 107 with DM were divided into observation group, the rest 79 patients without DM as control group. Baseline ,history ,BUN,CRE,LVEF and NT-proBNP of all the patients were collected when admitted. The AKI morbidity, mortality and hospitalized period were recorded, calculated and compared. The incidence of cardiovascular events was asked during the 6-month follow up.Compare the differences of mortality between the AKIs and non-AKIs in the subgroups. Results The morbidity and mortality of DM patients were obviously higher, and the hospitalized period was longer(P0.05);The incidence of cardiovascular events was higher in observation group(P0.05).Mortality of AKI patients were higher in both groups(P0.05). Conclusion The morbidity, in hospital mortality and cardiovascular events were higher in aged diabetes with AHF., The outcomes even worse if AKI happened in hospital. Keywords: Acute kidney injury;Acute heart failure;Diabetes mellitus;Geriatric paitents 急性心力衰竭患者合并急性肾损伤的发病率高达27%~45%[1,2,3,4]，尤其是老年人多见。随着糖尿病发生率的增加, 糖尿病合并急性心衰的患者越来越多，长期血糖升高引起微血管及心肌的病变，不仅加重了心衰，也对肾功能也产生了影响。针对老年