不同左室射血分数水平与心力衰竭人群肾功能障碍的关联性研究

Study on the Association between Different Levels of Left Ventricular Ejection Fraction and Renal Dysfunction in Patients with Heart Failure

摘要: 目的：探讨不同左室射血分数(LVEF)水平与心力衰竭人群肾功能障碍的关联。方法：以2006年至2018年期间参与开滦集团健康体检并于2020年12月31日前首次确诊心力衰竭的个体为研究对象，按照LVEF < 40%、40% ≤ LVEF < 50%、LVEF ≥ 50%进行分组，作为自变量，以是否存在肾功能损害为因变量，构建二元Logistic回归模型，计算比值比(OR)及其95%置信区间(CI)。同时，按年龄、性别及肥胖进行亚组分析。此外，通过分别排除高血压、糖尿病、心肌梗死病史及既往CKD患者，开展敏感性分析以验证结果的稳健性。结果：本研究共纳入3272名研究对象，其中男性2837人(86.7%)，平均年龄为(68.01 ± 10.99岁)。Logistic回归分析结果显示，以LVEF ≥ 50%为参照组，不同LVEF水平对肾功能障碍的影响分别为：40% ≤ LVEF < 50%组OR = 1.73 (1.31~2.29)，LVEF < 40%组OR = 2.42 (1.72~3.41)。亚组分析表明，除女性组未见统计学差异外，其余亚组结果与总体分析一致。结论：随着LVEF逐渐下降，心衰人群肾功能障碍风险逐渐增高。

Abstract: Objective: To investigate the association between different levels of left ventricular ejection fraction (LVEF) and renal dysfunction in patients with heart failure. Methods: Individuals who participated in the Kailuan Group health examinations between 2006 and 2018 and were first diagnosed with heart failure by December 31, 2020, were included as the study population. Participants were categorized into three groups based on LVEF levels: LVEF < 40%, 40% ≤ LVEF < 50%, and LVEF ≥ 50%. LVEF was used as the independent variable, and the presence of renal dysfunction was used as the dependent variable. A binary logistic regression model was constructed to calculate odds ratios (ORs) and their 95% confidence intervals (CIs). Subgroup analyses were performed according to age, sex, and obesity. Additionally, sensitivity analyses were conducted by excluding individuals with a history of hypertension, diabetes, myocardial infarction, or pre-existing chronic kidney disease (CKD) to verify the robustness of the results. Results: A total of 3272 participants were included in this study, of whom 2837 (86.7%) were male, with a mean age of 68.01 ± 10.99 years. Logistic regression analysis showed that, compared with the reference group (LVEF ≥ 50%), the odds ratios (ORs) for renal dysfunction were 1.73 (95% CI: 1.31~2.29) in the 40% ≤ LVEF < 50% group and 2.42 (95% CI: 1.72~3.41) in the LVEF < 40% group. Subgroup analysis revealed that, except for the female subgroup, which showed no statistically significant difference, the results were consistent with the overall analysis across all other subgroups. Conclusion: The risk of renal dysfunction increases progressively with the decline in LVEF among patients with heart failure.