老年患者充血性心力衰竭的危险因素分析  

Risk factors related to congestive heart failure in elderly patients

作　　者：缪培智[1] 卞士平[1] 郑宏超[1] 

机构地区：[1]上海市徐汇区中心医院心内科,200031

出　　处：《国际心血管病杂志》2015年第3期198-201,共4页International Journal of Cardiovascular Disease

基　　金：上海市卫生和计划生育委员会科研课题资助项目(20114306)

摘　　要：目的：分析老年患者充血性心力衰竭（CHF）的危险因素。方法：788例年龄〉60岁的老年住院患者,其中162例心功能NYHA分级Ⅰ级且左心室射血分数LVEF〉50%为对照组,其余626例心功能NYHA分级Ⅱ~Ⅳ级且LVEF≤40%患者为CHF组。比较两组临床特征和实验室指标,并采用多因素Logistic逐步分析,探讨老年患者CHF的独立危险因素。结果：与对照组比较,CHF组冠心病、高血压病和快速心房颤动比例显著增高,收缩压、血清尿酸、肌酐、高敏C反应蛋白（hs-CRP）、N-末端B型利钠肽原（NT-proBNP）水平也增高,且增高程度随心功能恶化而加重;但CHF组血红蛋白水平降低。CHF组血管紧张素转化酶抑制剂、血管紧张素受体拮抗剂、地高辛、β受体阻滞剂的使用率高于对照组（P〈0.01）。多因素Logistic逐步回归分析显示,快速心房颤动、高尿酸血症、贫血、肾功能不全、hs-CRP和NT-proBNP增高是老年患者发生CHF的独立危险因素。结论：老年患者CHF受多个危险因素的影响。血清肌酐、hs-CRP和NT-proBNP水平可能部分反映老年CHF患者的病情严重性。Objective：To analyze the potential risk factors related to congestive heart failure（CHF）in elderly patients. Methods：Among a total of 788 elderly in-hospital patients,162 patients were in NYHA classⅠ and had left ventricular ejection fraction（LVEF）〉50%（control group）and the remaining 626 patients were in NYHA classⅡ~Ⅳ and had LVEF ≤40%（CHF group）.Demographic and clinical characteristics and biochemical measurements were compared between the two groups.Multivariate stepwise Logistic analysis was performed to determine independent risk factors for CHF.Results：Compared with control group,patients in CHF group had a higher incidence of history of coronary heart disease,hypertension and atrial fibrillation with rapid ventricular rate.Systolic blood pressure and serum levels of uric acid,creatinine,hs-CRP and NT-proBNP were significantly elevated but hemoglobin was lower in CHF group（P〈0.05 and P〈0.01,respectively）.Elevation of serum levels of creatinine,hs-CRP and NT-proBNP correlated with the severity of CHF. Multivariate stepwise Logistic analysis showed that atrial fibrillation with rapid ventricular rate,hyperuricemia,anemia,renal insufficiency,hs-CRP and NT-proBNP were independently associated with CHF in elderly patients.The use of ACEI/ARB,digoxin andβblocker was more common in CHF group than in controls（all P〈0.05）. Conclusions：In elderly patients,the occurrence of CHF is determined by multiple clinical and biochemical factors.The degree of increase in serum creatinine,hs-CRP and NT-proBNP reflects at least partly the severity of CHF in these patients.

关 键 词：老年 充血性心力衰竭 危险因素 高敏C反应蛋白 N-末端B型利钠肽原 

分 类 号：R541.6[医药卫生—心血管疾病]