摘要
目的 探讨不同红细胞比容(HCT)水平对老年女性心力衰竭(心衰)患者3年不良结局的影响。方法 选择2014~2016年在天津医科大学总医院及天津市胸科医院这两家医院门诊就诊的症状性老年女性心衰患者561例,排除了91例缺少实验室检查指标的患者、7例患有严重血液病或恶性肿瘤的患者及99例失访患者,最终纳入364例症状性老年女性心衰的患者,根据HCT水平不同分为3组,HCT<37%(HCT低水平组)124例,HCT 37%~45%(HCT正常水平组)123例,HCT>45%(HCT高水平组)117例。通过门诊或电话进行为期3年的随访,采用logistic回归分析不同HCT水平对老年女性心衰患者3年不良结局的影响。结果 与HCT低水平组比较,HCT正常水平组血钠、血红蛋白、红细胞计数及左心室内径显著升高,HCT高水平组血管紧张素转换酶抑制剂比例显著降低(P<0.05)。随访结束88例患者出现心衰再住院,93例患者出现心因死亡,109例患者出现全因死亡;与HCT低水平组比较,HCT高水平组心衰再住院、心因死亡、全因死亡显著增高,差异有统计学意义(P<0.05)。单因素logistic回归分析显示,年龄、肾功能不全、血红蛋白、HCT>45%是3年全因病死率的影响因素(OR=1.041,95%CI:1.012~1.072,P=0.006;OR=3.091,95%CI:1.863~5.127,P=0.000;OR=0.986,95%CI:0.973~0.998,P=0.025;OR=3.429,95%CI:1.969~5.969,P=0.000)。多因素logistic回归分析显示,肾功能不全和HCT>45%是3年全因病死率的影响因素(OR=3.357,95%CI:1.954~5.766,P=0.000;OR=3.842,95%CI:2.151~6.862,P=0.000)。结论 高HCT水平是3年心因死亡及全因病死率的影响因素。
Objective To investigate the effect of different levels of hematocrit(HCT) on 3-year adverse outcome in elderly female patients with heart failure.Methods A total of 561 symptomatic elderly women with heart failure admitted to the outpatient departments of Tianjin Chest Hospital and Tianjin Medical University General Hospital from 2014 to 2016 were enrolled in this study.After 91 patients with missing laboratory parameters, 7 patients with severe hematological diseases or malignancies and 99 patients who were lost to follow-up were excluded, 364 elderly women with heart failure were finally included, and then were divided into 3 groups according to the normal range of HCT,which were defined as low(<37%,n=124),normal(37%≤HCT≤45%,n=123) and high level of HCT(>45%,n=117).All of these patients were followed up for 3 years by clinic visit or telephone.Logistic regression model was used to analyze the effects of different hematocrit levels on the 3-year adverse outcome of elderly female patients with heart failure.Results Compared with the low HCT group, the serum sodium and hemoglobin levels, red blood cell count and left ventricular diameter were significantly increased in the normal HCT group, and the proportion of using angiotensin converting enzyme inhibitor was obviously decreased in the high HCT group(P<0.05).At the end of follow-up, 88 patients were hospitalized due to heart failure, 93 patients died of cardiac causes, and 109 patients had all-cause death.The high HCT group had notably higher rates of heart failure rehospitalization, cardiac death and all-cause death than the low HCT group(P<0.05).Univariate logistic regression analysis showed that age, renal insufficiency, hemoglobin and HCT>45% were the influencing factors of 3-year all-cause mortality(OR=1.041,95%CI:1.012-1.072,P=0.006;OR=3.091,95%CI:1.863-5.127,P=0.000;OR=0.986,95%CI:0.973-0.998,P=0.025;OR=3.429,95%CI:1.969-5.969,P=0.000).Multivariate logistic regression analysis indicated that renal insufficiency and HCT >45% were the influencing facto
作者
康元
牛晓菁
史秩菁
李明雪
王聪琳
丛洪良
田建立
Kang Yuan;Niu Xiaojing;Shi Zhijing;Li Mingxue;Wang Conglin;Cong Hongliang;Tian Jianli(Department of Health and Medical Care,Tianjin Medical University General Hospital,Tianjin 300052,China)
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2022年第9期908-911,共4页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
天津市心脏学会科研项目(THA2020YB01)。
