摘要
背景随着人口老龄化加剧,≥60岁的老年心力衰竭(HF)患者逐年增加,营养状况与老年患者健康状况息息相关,但有关老年HF患者营养状况对预后影响的研究较少。目的探讨合并冠心病的老年射血分数保留心力衰竭(HFpEF)患者的营养状态与预后的关系。方法采用回顾性队列研究,选取2017-2019年于首都医科大学附属北京同仁医院西区老年医学科住院的老年HFpEFⅡ~Ⅳ级合并冠心病患者379例,收集患者病例资料、实验室检查结果,随访患者出院1年内因HF再入院和HF全因死亡情况。以营养控制状态(CONUT)评分、老年人营养风险指数(GNRI)和预后营养指数(PNI)评估患者营养状态。将患者分为无营养不良风险组(CONUT评分0~1分,n=42)、低营养不良风险组(CONUT评分2~4分,n=181)、中高营养不良风险组(CONUT评分5~12分,n=156),比较三组间临床资料和预后的差异。采用单因素及多因素Logistic回归分析探讨患者1年内因HF再入院和1年内HF全因死亡的影响因素,采用受试者工作特征曲线(ROC曲线)分析CONUT评分、GNRI、PNI对患者1年内因HF再入院和1年内HF全因死亡的预后价值。结果三组年龄、高龄患者比例、性别、体质指数(BMI)、卧床、住院时间、NYHA分级、血红蛋白、淋巴细胞、尿素氮、肌酐、总蛋白、血清白蛋白、三酰甘油、总胆固醇、低密度脂蛋白胆固醇、B型脑钠肽(BNP)、1年内HF全因死亡比较,差异有统计学意义(P<0.05);其中无营养不良风险组、低营养不良风险组年龄、高龄患者比例、卧床、住院时间、NYHA分级、陈旧性心肌梗死、尿素氮、肌酐、三酰甘油、总胆固醇、低密度脂蛋白胆固醇、BNP、1年内HF全因死亡均低于中高营养不良风险组,差异有统计学意义(P<0.05),BMI、血红蛋白、淋巴细胞、总蛋白、血清白蛋白、三酰甘油、总胆固醇、低密度脂蛋白胆固醇均高于中高营养不良风险组,差异有�
Background The prevalence of heart failure(HF)is growing in a rapidly increased number of older adults(≥60 years),which,together with older age,produces an impact on nutritional status of the HF cases.But there are relatively few studies on the impact of nutritional status on the prognosis in elderly patients with chronic HF.Objective To investigate the association of nutritional status with prognosis in elderly patients with HF with preserved ejection fraction(HFpEF)and coronary heart disease.Methods A retrospective cohort study was conducted.Inpatients with HFpEF and coronary heart disease(≥60 years old,NYHA gradeⅡ-Ⅳ)treated in Department of Geriatrics,Beijing Tongren Hospital,Capital Medical University between 2017 and 2019 were enrolled.Clinical and laboratory data were collected.HF-related readmission and all-cause mortality within one year after discharge were followed up.Nutritional status was evaluated by controlling nutritional status(CONUT)score,geriatric nutritional risk index(GNRI)and prognostic nutritional index(PNI).Patients were divided into non-malnutrition group(CONUT score 0-1,n=42),low malnutrition risk group(CONUT score 2-4,n=181)and medium-high malnutrition risk group(CONUT score 5-12,n=156).The differences in clinical data and prognosis among the three groups were compared.Univariate and multivariate logistic regression analyses were used to explore the influencing factors of readmission due to HF and all-cause mortality within one year after discharge.ROC analysis was used to analyze the prognostic value of CONUT score,GNRI and PNI for readmission due to HF and all-cause mortality within 1 year after discharge.Results Age,proportion of elderly patients,sex,BMI,bed rest,length of hospital stay,NYHA grade,hemoglobin,lymphocytes,urea nitrogen,creatinine,total protein,albumin,triacylglycerol,total cholesterol,low density lipoprotein cholesterol,B-type brain natriuretic peptide(BNP),all-cause death within 1 year were compared among the three groups,and there were statistically significan
作者
陈莹
郑辉
何玉
CHEN Ying;ZHENG Hui;HE Yu(Department of Geriatrics,Beijing Tongren Hospital(West),Capital Medical University,Beijing 100730,China)
出处
《中国全科医学》
CAS
北大核心
2023年第3期335-342,共8页
Chinese General Practice
关键词
心力衰竭
射血分数保留心力衰竭
冠心病
营养控制状态评分
预后:老年
Heart failure
Heart failure with preserved ejection fraction
Coronary disease
Controlling nutritional status score
Prognosis
Elderly
