重度慢性心力衰竭患者近期预后影响因素的回顾性分析  

Retrospective analysis of the factors influencing short-term prognosis in patients with severe chronic heart failure

作　　者：王霞[1] 郭俊林[2] 黄小鲁[1] 薛克栋[1] WANG Xia GUO Jun-lin HUANG Xiao-lu XUE Ke-dong(The People＇s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang 830054, Chin)

机构地区：[1]新疆维吾尔自治区人民医院,新疆乌鲁木齐830054 [2]广安市人民医院

出　　处：《实用预防医学》2017年第5期552-554,共3页Practical Preventive Medicine

基　　金：四川省医学科研课题(S15031)

摘　　要：目的探讨低钠血症及传统心血管危险因素对重度慢性心力衰竭(CHF)患者预后的预测价值。方法收集2014年4月-2015年1月于新疆维吾尔自治区人民医院住院,按纽约心脏病协会(NYHA)法分为心功能Ⅳ级189例CHF患者为研究对象,对其随访6月,通过电话访问及回顾患者再入院就诊的医疗记录方式记录随访信息。记录的全因死亡指患者在随访期间死亡,包括心因性死亡及非心因性死亡。按随访结果将患者分为事件组和对照组,采用多因素logistic回归分析低钠血症及心血管传统危险因素对重度CHF患者预后的预测价值。结果事件组入院低钠血症发生率(21.9%vs.12.0%,P=0.027),糖尿病发生率(48.4%vs.28.0%,P=0.006)、血清N末端脑钠尿肽前体(NT-proBNP)[(1 841.2±231.5)pg/ml vs.(1 426.5±164.3)pg/ml,P<0.001)明显高于对照组。多因素logistic回归分析显示,低钠血症(OR=1.624,95%CI:1.024~4.225,P=0.036),高血清NT-proBNP水平(OR=1.214,95%CI:1.178~4.460,P<0.001)、糖尿病(OR=2.415,95%CI:1.321~4.643,P=0.038)是重度慢性心衰患者6月内全因死亡发生的独立危险因素。结论入院时低钠血症、高血清NT-proBNP水平、糖尿病是重度慢性心衰患者6月随访期内全因死亡的独立危险因素。Objective To explore the predictive value of hyponatremia and traditional cardiovascular risk factors in forecasting the prognoses of patients with severe chronic heart failure （ CHF）. Methods We recruited 189 CHF inpatients with Class IV heart function based on the classification criteria by New York Heart Association （ NYHA ） in the People＇ s Hospital of Xinjiang Uygur Autonomous Region from April 2014 to January 2015. A 6-month follow-up was conducted, and the follow-up information was recorded through telephone interview and retrospective analysis of medical records of the rehospitalizd patients. The recorded all -cause mortality presented the deaths of the inpatients during the follow-up, including cardiogenie deaths and non-cardiogenic deaths. All the inpatients were divided into the event group and the control group according to the results of the follow-up. Multi- factor logistic regression analysis was used to analyze the predictive value of hyponatremia and traditional cardiovascular risk factors in forecasting the prognoses of the inpatients with severe CHF. Results The incidence rates of hyponatremia （ 21.9% vs. 12. 0%, P= 0.027） and diabetes mellitus （48.4% vs. 28.0%, P= 0.006） as well as serum N-terminal brain natriuretic propeptide （NT-proBNP） level （ （ 1,841.2＋231.5 ） pg/ml vs. （ 1,426.5＋ 164.3 ） pg/ml, P〈0.001 ） were significantly higher in the event group than in the control group. Multi-factor logistic regression analysis revealed that hyponatremia （OR = 1.624, 95% CI： 1. 024- 4. 225, P=0.036） , higher serum NT-proBNP level （OR= 1.214, 95%CI：1.178-4.460, P〈0.001） and diabetes mellitus （OR= 2.415, 95%CI： 1. 321-4. 643, P= 0. 038） were the independent risk factors for the occurrence of all-cause mortality during the 6 -month follow-tip in the inpatients with severe CHF. Conclusions Hyponatremia, high serum NT-proBNP level and complicaiton with diabetes mellitus on hospitalization are the independent risk factors for all-cause mortality d

关 键 词：低钠血症 NT-PROBNP水平 糖尿病 心力衰竭 全因死亡 预后 

分 类 号：R541.6[医药卫生—心血管疾病]