慢性腎臓病を合併した慢性心不全患者における運動耐容能とその関連要因の検討  [in Japanese] Determinants of Exercise Capacity in Chronic Heart Failure Patients with Chronic Kidney Disease  [in Japanese]

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Author(s)

    • 堀田 千晴 HOTTA Chiharu
    • 川崎市立多摩病院リハビリテーション科 Department of Rehabilitation Medicine, Kawasaki Municipal Tama Hospital
    • 平木 幸治 HIRAKI Koji
    • 聖マリアンナ医科大学病院リハビリテーション部 Department of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital
    • 渡辺 敏 WATANABE Satoshi
    • 聖マリアンナ医科大学病院リハビリテーション部 Department of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital
    • 井澤 和大 IZAWA Kazuhiro P.
    • 聖マリアンナ医科大学病院リハビリテーション部 Department of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital
    • 安田 隆 YASUDA Takashi
    • 聖マリアンナ医科大学腎臓・高血圧内科 Division of Nephrology and Hypertension, Department of Medicine, St. Marianna University School of Medicine
    • 長田 尚彦 OSADA Naohiko
    • 聖マリアンナ医科大学循環器内科 Division of Cardiology, Department of Medicine, St. Marianna University School of Medicine
    • 大宮 一人 OMIYA Kazuto
    • 聖マリアンナ医科大学循環器内科 Division of Cardiology, Department of Medicine, St. Marianna University School of Medicine

Abstract

【目的】本研究の目的は,慢性心不全(CHF)患者の運動耐容能を腎機能別に調査し,慢性腎臓病(CKD)合併CHF患者の運動耐容能関連要因について明らかにすることである。【方法】男性CHF患者119例を対象に推算糸球体濾過量(eGFR)を基に,A群(eGFR60以上),B群(eGFR30以上60未満),C群(eGFR30未満)の3群に選別し,運動耐容能および上下肢筋力を比較した。さらにB・C群(CKD群)の運動耐容能関連要因を検討した。【結果】腎機能別の3群間の比較では,運動耐容能,膝伸展筋力,握力は,eGFRが低い群で有意に低値を示した。さらに,CKD群の運動耐容能関連要因を重回帰分析にて検討した結果,膝伸展筋力とeGFR(R = 0.68,R<sup>2</sup> = 0.44,<i>p</i> < 0.001)が抽出された。【結語】CHF患者では,腎機能低下にともない運動耐容能は低下した。また,CKD合併CHF患者の運動耐容能関連要因に,膝伸展筋力とともにeGFRが抽出された。

<b>Purpose</b>: The purpose of this study was to investigate both the exercise capacity of chronic heart failure (CHF) patients exercise capacity according to renal function and the determinants of exercise capacity in CHF patients with chronic kidney disease (CKD). <br><b>Methods</b>: The study population was comprised of 119 male CHF patients. Patients were divided into three groups according to their estimated glomerular filtration rate (eGFR): group A (eGFR ≧ 60), group B (30 ≦ eGFR < 60), and group C (eGFR < 30). After dividing the patients into groups, exercise capacity and knee extensor and hand grip muscle strength were compared among the three groups. Furthermore, groups B and C were defined as the CKD group, and relevant factors related to exercise capacity were examined. <br><b>Results</b>: Exercise capacity and all muscle strength indices decreased as eGFR decreased. Stepwise linear regression analysis revealed that knee extensor muscle strength and eGFR were significant important factors in predicting exercise capacity in CHF patients with CKD (R = 0.68, R<sup>2</sup> = 0.44, <i>p</i> < 0.001). <br><b>Conclusions</b>: In CHF patients, exercise capacity decreased with declining renal function. Moreover, knee extensor muscle strength and eGFR were determined to be important factors in predicting exercise capacity in CHF patients with CKD.

Journal

  • Physical Therapy Japan

    Physical Therapy Japan 38(6), 436-441, 2011

    Japanese Society of Physical Therapy

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