不同舒张压水平对老年射血分数保留的心衰患者预后的影响分析  

Effect of different diastolic blood pressure levels on the prognosis of elderly patients with heart failure with preserved ejection fraction

作　　者：冯莉[1] 林萍[1] 谢晓枫 王琴[1] 梁丽贞[1] FENG Li;LIN Ping;XIE Xiao-feng(Department of Integrated Medicine, Hangzhou Third People’s Hospital,Hangzhou, Zhejiang 310008 , China)

机构地区：[1]杭州市第三人民医院综合一科

出　　处：《中华全科医学》2019年第10期1694-1696,1704,共4页Chinese Journal of General Practice

基　　金：浙江省中医药科技计划项目(2018Z05);浙江省医药卫生科技计划项目(2018KY593)

摘　　要：目的分析舒张压水平不同的射血分数保留心力衰竭(heart failure with preserved ejection fraction,HFpEF)老年患者心功能分级及心脏不良事件发生情况,以及其对该类患者预后的影响。方法选择2015年3月—2016年12月于杭州市第三人民医院治疗的老年HFpEF患者进行为期1.5年的随访,其中63例失访,完成随访的207例患者按照入院时监测24 h平均舒张压(diastolic blood pressure,DBP)水平分为LDBP组(24h DBP<60mmHg,1mmHg=0.133kPa,98例)和HDBP组(24h DBP≥60mmHg,109例),分析2组心功能分级、死亡率、非致死性心肌梗死、心源性休克发生情况。按照随访1.5年后的全因死亡情况分为死亡组和存活组,比较2组的一般资料及临床资料,应用多因素Cox回归分析影响老年HFpEF患者死亡的独立危险因素。结果 LDBP组的心功能分级严重度、死亡率、非致死性心肌梗死和心源性休克发生率均高于HDBP组(均P<0.05)。随访1.5年,105例患者死亡(死亡组),存活组102例。单因素分析显示,死亡组与存活组在24h DBP、BMI、COPD发生率、NT-proBNP以及IVST水平方面差异有统计学意义(均P<0.05)。多因素Cox回归分析显示,舒张压<60mmHg、高IVST水平是患者死亡的独立危险因素(均P<0.05)。结论低舒张压和高IVST是HFpEF患者死亡的独立危险因素,对HFpEF患者应重视其舒张压水平。Objective To analyze the cardiac function and the adverse outcomes in elderly HFpEF patients with different diastolic blood pressure,and explore the risk factors of death. Methods A total of 207 participants enrolled in this study from March 2015 December 2016 were divided into LDBP group(24h mean diastolic blood pressure <60mmHg, 1mmHg=0.133kPa, n=98) and HDBP group(24 h mean diastolic blood pressure ≥60mmHg, n=109). NYHA function classification Ⅲ or Ⅳ, all-cause death, the incidence of non-fatal myocardial infarction and cardiac shock were analyzed. The patients were followed up for 1.5 years with the end point of all-cause death. Risk factors of death were analyzed by Cox regression. Results The severity of cardiac function, mortality, non-fatal myocardial infarction and cardiogenic shock in the LDBP group were higher than those in the HDBP group(all P<0.05). A total of 105 deaths(death group) were observed in 1.5 years of follow-up, and 102 in the survival group. Univariate analysis showed that there were differences in DBP, BMI, COPD, NT-proBNP and IVST levels between the death group and the survival group(all P<0.05). Multivariate Cox regression analysis showed that diastolic blood pressure <60mmHg and high IVST level were independent risk factors for death(all P<0.05). Conclusion Low DBP and high IVST increase the risks of death in HFpEF patients.

关 键 词：射血分数保留心力衰竭 舒张压 危险因素 死亡 室间隔厚度 

分 类 号：R541.6[医药卫生—心血管疾病] R443.5[医药卫生—内科学]