摘要
目的:研究贫血对老年射血分数保留型心力衰竭(HFpEF)合并慢性肾脏病(CKD)患者不良心血管事件的预测价值。方法:本研究为前瞻性研究,共纳入2020年6月至2023年6月在福建省老年医院就诊的215例老年HFpEF合并CHD的患者,按照入院时的血红蛋白(Hb)水平分为贫血组129例(男性Hb<130g/L或女性Hb<120g/L)和无贫血组86例。收集两组完整的人口统计数据、生命体征、纽约心脏病协会(NYHA)心功能分级,以及超声心动图、胱抑素C(CysC)、N末端脑钠肽前体(NT-proBNP)、肌酐等临床指标。所有患者出院后每月随访1次,共随访12个月,终点事件为心力衰竭(HF)再入院及心源性死亡。比较两组临床指标;采用Kaplan-Meier生存分析比较两组终点事件的累积发生率;采用多因素Logistic回归分析老年HFpEF合并CKD患者随访12个月发生终点事件的影响因素,采用ROC曲线分析不同指标单独及联合检测对此类患者终点事件的预测价值。结果:老年HFpEF合并CKD患者贫血比例为60%(129/215)。与无贫血组比较,贫血组患者估测的肾小球滤过率(eGFR)显著降低,肌酐、CysC与NT-proBNP水平均显著升高(P均<0.01)。Pearson相关分析显示,Hb水平与eGFR呈显著正相关(r=0.428,P<0.001),与NT-proBNP呈显著负相关(r=-0.282,P<0.001)。Kaplan-Meier生存分析显示,随访12个月期间,贫血组患者HF再入院及心源性死亡发生率显著高于无贫血组患者(Log-rankχ2=15.141,P<0.001)。多因素Logistic回归分析显示,CysC和NT-proBNP是老年HFpEF合并CKD患者随访12个月期间发生HF再入院及心源性死亡的独立危险因素(OR=6.871、1.000,P均=0.039);而Hb是其独立保护因素(OR=0.954,P<0.001)。ROC曲线分析结果显示NT-proBNP、CysC和Hb联合诊断老年HFpEF合并CKD患者随访12个月期间发生HF再入院及心源性死亡的曲线下面积(AUC)为0.839(95%CI 0.779~0.898),显著高于NT-proBNP(AUC=0.719)单独检测(Z=1.698,P=0.015),但与Hb、CysC单独检测无显�
Objective:This study aims to investigate the predictive value of anemia for adverse cardiovascular events in elderly patients with heart failure with preserved ejection fraction(HFpEF)and chronic kidney disease(CKD).Methods:This prospective study enrolled 215 elderly patients with HFpEF and CKD treated in Fujian Provincial Geriatric Hospital between June 2020 and June 2023.According to hemoglobin(Hb)level at admission,patients were divided into anemia group(n=129,Hb<130 g/L in males and Hb<120 g/L in females)and no anemia group(n=86).Complete demographic data,vital signs,New York Heart Association(NYHA)class,and clinical indicators including echocardiographic data,cystatin C(CysC),N-terminal pro-B-type natriuretic peptide(NT-proBNP)and creatinine(Cr)etc.were collected in two groups.All patients were followed up monthly for 12 months after discharge.The primary endpoints included heart failure(HF)-caused readmission and cardiac death.Clinical indicators were compared between two groups;Kaplan-Meier survival analysis was used to compare accumulative incidence rate of endpoint events between two groups;multivariate Logistic regression was used to analyze influencing factors of endpoint events in elderly patients with HFpEF and CKD during 12-month follow-up,and ROC curve was applied to analyze predictive value of single and combined detection of different indicators for endpoint events in these patients.Results:Incidence rate of anemia was 60%(129/215)in elderly patients with HFpEF and CKD.Compared with those in no anemia group,patients in anemia group had significant lower estimated glomerular filtration rate(eGFR),and significant higher levels of Cr,CysC and NT-proBNP(P<0.01 all).Pearson correlation analysis indicated that Hb level was significant positively correlated with eGFR(r=0.428,P<0.001),and significant inversely correlated with NT-proBNP(r=-0.282,P<0.001).Kaplan-Meier survival analysis indicated that during 12-month follow-up,incidence of HF-caused readmission and cardiac death in anemia group was signific
作者
张忠武
林璋
王世红
ZHANG Zhong-wu;LIN Zhang;WANG Shi-hong(Department of Cardiology,Fujian Provincial Geriatric Hospital,Fuzhou,Fujian,350003,China)
出处
《心血管康复医学杂志》
CAS
2024年第5期568-574,共7页
Chinese Journal of Cardiovascular Rehabilitation Medicine
基金
福建省自然科学基金资助项目(2022J01434)。
