血清低白蛋白对老年心力衰竭患者院内死亡的预测价值  

Prognostic value of hypoalbuminemia for in-hospital mortality in elderly patients with heart failure

作　　者：任晓红[1] 金丽[1] 李玉荣[1] 方慧娟[1] 崔东勤 曲巍[1] 

机构地区：[1]辽宁省沈阳市第四人民医院干诊科,110031

出　　处：《临床内科杂志》2016年第10期679-682,共4页Journal of Clinical Internal Medicine

摘　　要：目的探讨血清低白蛋白对老年心力衰竭（心衰）患者院内死亡的预测价值。方法将810例心衰住院患者，按血清白蛋白水平分为两组：白蛋白正常组（血清白蛋白≥35g／L）和低白蛋白组（血清白蛋白〈35g／L）。以全因院内死亡为主要终点，通过多因素COX回归评价血清低白蛋白对心衰患者院内死亡的预测价值。结果810例患者中210例出现血清低白蛋白，占25．9％。与白蛋白正常组相比，低白蛋白组患者年龄更大，心功能纽约分级、肌酐、脑钠肽水平更高，扩张性心肌病、瓣膜病更多，高血压、左心室射血分数≥45％比例更少，入院收缩压、血红蛋白、总蛋白、胆固醇、血钠、左心室射血分数更低，心率更快。与白蛋白正常组相比，低白蛋白组的速尿、螺内酯、洋地黄使用比例更高，但他汀使用比例更低。正常白蛋白患者的院内死亡7例，其病死率为1．2％；而血清低白蛋白患者的院内死亡12例，其病死率为5．7％。COX比例风险回归分析显示，即使校正了所有混杂因素，血清白蛋白每下降1g／L，老年心衰患者的院内死亡风险就增加了19．1％（HR1．191，95％CI1．073～1．321；P〈0．01）；同时，老年心衰血清低白蛋白患者的院内死亡风险是白蛋白正常者的3．645倍（HR3．645，95％CI1．528～8．695；P〈0．01）。结论血清低白蛋白是预测老年住院心衰患者院内死亡的强独立危险因素。Objective To analyze the prognostic value of hypoalbuminemia for in-hospital mor- tality in elderly patients with heart failure. Methods We enrolled 810 consecutive heart failure patients, who were divided into hypoalbuminemia group （ 〈 35 g/L） and normal albuminemia group （ ≥ 35 g/L） according to serum albumin concentration on admission. Cox proportional-hazards regression modeling was used to evaluate the prognostic value of hypoalbuminemia for in-hospital mortality in elderly patients with heart failure. Results The hypoalbuminemia group was older, had higher NYHA status, creatinine and brain natriuretic peptide, more dilated cardiomyopathy and valvular heart disease,less hypertension and EF ≥45 % ;lower systolic blood pressure on admission, hemoglobin, total protein, total cholesterol, serum sodium on admission, and ejection fraction on admission;faster heart rate on admission;more rates of in-hospital use of intravenous furosemide, spirolactone and digitalis, but lower rates of in-hospital use of stain than normoalbuminemia group. During the admissions, there were 7 deaths （ 1.2% ） in normoalbuminemia group and 12 deaths（5.7% ） in hypoalbuminemia group. The multivariate Cox regression analysis indicated that when albumin decreased by per 1 g/L, the risk of in-hospital death in patients with heart failure increased 19.1% ;hypoalbuminemia group was associated with a 2. 645-fold greater risk of in-hospital death than normoalbuminemia group. Conclusion Hypoalbuminemia is a strong independent risk factor for in-hospital mortality in elderly patients with heart failure.

关 键 词：血清低白蛋白 老年 心力衰竭 院内死亡 

分 类 号：R541[医药卫生—心血管疾病]