总胆红素水平对住院慢性心力衰竭患者远期预后影响  

The impact of serum total bUirubin level on long-term prognosis in patients with chronic heart failure

作　　者：孙丽杰[1] 张福春[1] 李丹[1] 陈凤荣[1] 崔鸣[1] 高炜[1] 

机构地区：[1]北京大学第三医院心内科卫生部心血管分子生物学与调节肽重点实验室及分子心血管学教育部重点实验室,100191

出　　处：《中华内科杂志》2012年第9期677-679,共3页Chinese Journal of Internal Medicine

摘　　要：目的探讨住院慢性心力衰竭（CHF）患者TBil水平与远期预后的关系。方法回顾性分析140例CHF急性加重患者入院24h内血液学检查及心脏结构及功能参数，平均随访28．5个月，分析远期死亡的预测因子。结果入院时TBil≤12．8mmol／L组、TBil〉12．8～18．2mmol／L组、TBil〉18．2mmol／L组远期病死率分别为12．2％、17．9％和38．9％（P=0．002），脉压分别为（55．5±17．3、48．9±13．1、46．1±13．7）mmHg（1mmHg=0．133kPa）（P=0．008）。相关性分析显示TBil与右室内径、左室舒张末期内径明显相关（r分别为0．34、0．23）。多因素分析显示TBil和利钠肽是死亡的独立预测因子（P值分别为0．038、0．027）。结论CHF急性加重时，TBil水平增高预测其远期病死率增加。Objective To analyze the relationship between serum total bilirubin coincident with congestive heart failure （CHF） exacerbation and subsequent long-term mortality in patients with CHF. Methods The study population consisted of 140 consecutive patients admitted for CHF exacerbation with left ventrieular ejection fraction ≤45%. They were divided into 2 groups according to whether death attacked or not in the following 28.5 months. Binary logistie regression analysis was used to investigate independent predictors of death from clinical parameters on admission or within 24 hours. Results Serum TBil and Btype natriuretic peptide （BNP） levels on admission were independent predictors of subsequent death after hospital discharge. According to increasing textiles of TBil stratified by the level of 12. 8 and 18.2 mmol/L, the patients were divided into 3 groups： lower-level group （TBil ≤ 12. 8 mmol/L） , moderate-level group （TBil 〉 12. 8 -18.2 mmol/L） and higher-level group （TBil 〉 18.2 mmo]/L）, with the death rates after 28.5 months of 12. 2%, 17. 9% and 38.9% , respectively （ P = 0. 002 ）. Meanwhile, the pulse pressure decreased to （55.5 ± 17. 3） mm Hg （ 1 mm Hg =0. 133 kPa）, （48.9 ± 13. 1） mm Hg and （46. 1± 13.7） mm Hg, respectively （ P = 0. 008 ）. TBil on admission had significant correlation with echoeardiography- measured left ventricular endo-diastolie diameter （ r = 0. 34, P = 0. 000 ） and right ventrieular diastolic diameter （ r = 0. 23, P = 0. 011 ）. Conclusions Increased TBil coincident with cardiac deeompensation predicts a worse long-term death of CHF, presumably through the potential liability to both decompensated RV function and lower cardiac output syndrome occurred simultaneously when HF deteriorates.

关 键 词：心力衰竭 胆红素 预后 

分 类 号：R541.6[医药卫生—心血管疾病]