血脂水平对老年冠心病心力衰竭患者预后的影响  

Association between Lipid Level and Prognosis in Elder Patients with Chronic Heart Failure and Coronary Artery Disease

作　　者：宋芳[1] 王林[1] 

机构地区：[1]天津医科大学第二医院干部保健科,300211

出　　处：《天津医药》2012年第7期675-678,共4页Tianjin Medical Journal

摘　　要：目的:研究血脂水平与老年冠心病慢性心力衰竭(心衰)患者预后的关系。方法:将老年冠心病合并慢性心衰患者970例按血脂水平分为低水平组、较低水平组、较高水平组和高水平组。按随访期是否死亡分为死亡组(206例)和生存组(764例),按随访期间使用他汀类药物情况分为他汀组(531例)和非他汀组(439例),比较4项血脂成分各水平组的病死率。采用多因素Cox回归分析血脂对冠心病合并心衰患者预后的影响。结果:在他汀组和非他汀组,各高密度脂蛋白胆固醇(HDL-C)水平的病死率差异有统计学意义(P<0.05),总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)各水平组的病死率差异无统计学意义(P>0.05)。死亡组的年龄、合并陈旧性心肌梗死(OMI)、贫血、房颤、肾衰竭的比例大于生存组;死亡组的HDL-C、射血分数(EF)、服用血管紧张素转换酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)类和他汀类药物的比例小于生存组,差异有统计学意义(P<0.05或P<0.01)。年龄、NYHAⅢ～Ⅳ级、低水平和较低水平的HDL-C是冠心病心衰预后不良的危险因素,ACEI/ARB为保护因素,TG、TC、LDL-C各水平组对预后无明显影响。结论:提高HDL-C水平可能改善冠心病心衰患者的预后,TC、TG、LDL-C水平对冠心病心衰患者预后无明显影响。Objective： To study the association between the lipid levels and prognosis in elder patients with chronic heart failure （CHF） and coronary artery disease （CAD）. Methods： Nine hundred and seventy eider patients with CHF and CAD were divided into four groups including low level group, lower level group, higher level group and high level group, according to quartiles of lipid level. Patients were divided into two groups, death group （n=206） and survival group （n=764）, according to the result of follow-up. Patients also divided into two groups, statin group （n=531） and non-statin group （n=439）, according to their treatment in the follow-up period. The mortality and lipid levels were compared between groups. Cox regression analysis was used to confirm the associations of lipid levels and prognosis of elder patients with CHF and CAD. Results： There was a significant difference in mortality of each level of high density lipoprotein cholesterol （HDL-C） between statin group and non-statin group （P 〈 0.05）, but there was no significant association between levels of total cholesterol （TC）, triacylglycerol （TG）, low density lipoprotein cholesterol （LDL-C） and prognosis （P 〉 0.05）. Compared with living group, the proportion of old-age, old myocardial infarction （OMI）, anemia, atrial fibrillation and renal failure were larger in death patients. The HDL-C, ejection fraction （EF）, using angiotensin-converting enzyme inhibitors （ACEI）/angiotensin II receptor antagonist （ARB） and statin were significantly lower in death group than those of survival group （P 〈 0.05 or P 〈 0.01）. Multivariate Cox regress analysis showed that age, NYHA III-IV, the lowest and the lower level HDL-C were risk factors of poor prognosis for coronary heart disease with heart failure. ACEI/ARB was the protection factor for prognosis. But none of the quartiles of TC, TG or LDL-C could predict the mortality. Conclusion： HDL-C represented a novel prognostic factor for patients

关 键 词：冠心病 心力衰竭 胆固醇胆固醇 LDL 胆固醇 HDL 甘油三酯类 他汀类 预后 

分 类 号：R541.4[医药卫生—心血管疾病]