摘要
目的探讨老年重症射血分数保留心力衰竭(HFpEF)患者临床特点并对其预后因素进行分析。方法入选2011—2016年北京朝阳医院住院的纽约心脏协会(NYHA)心功能分级Ⅲ~Ⅳ级重症HFpEF患者308例,记录患者一般资料、生化指标、超声心电图等参数。按年龄分为<75岁组和≥75岁组。采用Kaplan-Meier生存曲线及Cox回归对患者预后及其影响因素进行分析。结果(1)共纳入分析286例,NYHAⅢ级171例,Ⅳ级115例,平均年龄71.3岁,死亡131例。≥75岁组142例,死亡80例,<75岁组144例,死亡51例。(2)≥75岁组女性多见;伴随高血压、糖尿病、卒中等疾病多;糖化血红蛋白、老年营养风险指数(GNRI)<92比例高于<75岁组;白蛋白、血红蛋白、肌酐清除率、左室舒张末期内径(LVEDD)及地高辛和β受体阻滞剂使用率明显低于<75岁组。≥75岁组死亡率明显高于<75岁组,P<0.001。(3)Cox多因素回归分析显示≥75岁组NT-proBNP、未服用血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB)、左室肥厚是其预后的独立危险因素。结论老年重症HFpEF患者一般状况差,伴随疾病多,死亡率高,预后差。NT-proBNP、未服用ACEI/ARB类药物、左室肥厚是其预后的独立危险因素。
Objectives To analyze the clinical characteristics and prognosis of elderly patients with severe heart failure with preserved ejection fraction(HFpEF).Methods Totally 308 HFpEF patients with NYHA classⅢ-Ⅳwere enrolled from2011 to 2016,and basic clinical data and other parameters were collected.Patients were divided into two groups according to age,<75 and≥75 years group.Kaplan-Meier survival curves and Cox regression were used to analyze the patients’prognosis and its influencing factors.Results(1)286 cases were enrolled in this analysis.The median age was 71.3 years.There were 171 and 115 patients belonging to NYHA functional classⅢandⅣrespectively.There were 142 patients in≥75 years group,and 80 cases were dead;144 patients were<75 years and 51 were dead.(2)The elderly patients were mostly women,and most were accompanied by hypertension,diabetes mellitus and stroke;the proportion of plasma glycated hemoglobin value(HbA1 c)and GNRI92 was higher than patients<75 years.Albumin,hemoglobin,creatinine clearance rate(Ccr),LVEDD and the usage rate of digoxin andβ-blockers were lower in≥75 group than in<75 years old group.Mortality of≥75 group was significantly higher than<75 years old group,P<0.001.(3)Multivariate Cox regression analyses revealed that NT-pro BNP,no treatment with angiotensin converting enzyme inhibitor(ACEI)or angiotensin receptor blocker(ARB)and left ventricular hypertrophy were independent risk factors for the prognosisi.Conclusions Elderly severe HFp EF patients are in poorer general condition and have more concomitant diseases,prognosis is worse.NT-pro BNP,no treatment with ACEI/ARB drugs and left ventricular hypertrophy are independent risk factors for the prognosis.
作者
党彩静
张婧
何珊
韩蒙蒙
王欣
王华
徐晓蓉
张涓
赵文淑
徐琳
DANG Cai-jing;ZHANG Jing;HE Shan;HAN Meng-meng;WANG Xin;WANG Hua;XU Xiao-rong;ZHANG Juan;ZHAO Wen-shu;XU Lin(Heart Center and Beijing Key Laboratory of Hypertension Research,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2021年第8期710-714,共5页
Chinese Journal of Practical Internal Medicine
基金
首都医科大学基础临床科研合作项目(15JL04)。
关键词
老年
重症
射血分数保留心力衰竭
elderly
severe
preserved ejection fraction heart failure patients
