血液浓缩对急性心力衰竭患者中期预后的影响  

Relation between hemoconcentration status and medium-term progrosis in patients with acute heart fail-ure

作　　者：张倩[1] 王春梅[1] 孙晓东[1] 魏璐佳 艾辉[1] 郭畅[1] 聂绍平[1] ZHANG Qian;WANG Chunmei;SUN Xiaodong;WEI Lujia;AI Hui;GUO Chang;NIE Shaoping(Department of Emergency,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所急危重症中心,100029

出　　处：《心肺血管病杂志》2021年第9期912-915,926,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家高技术研究发展计划(863)重大项目(2015AA020102)。

摘　　要：目的:探讨血液浓缩(HC)对急性心力衰竭患者中期预后的预测价值。方法:连续入选2017年1月到2018年6月,在我院急诊住院的急性心力衰竭患者738例。将患者分为两组,出院时HGB和红细胞压积均升高的患者分入血液浓缩组,其他患者分入非血液浓缩组。观察所有患者2年内因为心脏原因的再住院率和全因死亡率。结果:所有患者出院时,有304例患者分入血液浓缩组(HC),与非血液浓缩组(NC)相比,HC组患者入院时心率更快,肾小球滤过率(eGFR)更高,BNP更低[(89.7±20.6)vs.(86.4±19.5)次/min,(62.6±23.7)vs.(56.8±22.5)mL·min^(-1)·1.73m^(-2),1753(1073,2507)vs.1882(1132,2554)ng/L,P<0.05];在观察指标上,HC组相比NC组患者住院时间更长,出院时体质量下降多[(8.5±2.3)vs.(7.2±2.1)d,(2.8±0.2)vs.(1.9±0.1)kg,P<0.001]。随访2年中,HC组和NC组的死亡人数分别为115例(37.8%)和203例(46.8%),通过Kaplan-meier生存分析发现HC组的死亡率更低(P=0.013)。进一步多因素回归显示出院时血液浓缩是预测心脏原因再住院或者死亡的独立危险因素(HR=0.58,95%CI:0.39~0.82,P=0.017)。结论:急性心力衰竭患者出院时的血液浓缩情况与2年的全因死亡或者心脏原因再住院相关。Objective: To investigate relation between hemoconcentration status and medium-term progrosis in patients with acute heart failure. Methods: We included 738 consecutive patients with acute heart failure, from Jan.2017-Jun.2018. Patients were divided into two groups based on their hemoconcentration status at discharge. HC group was patients with increased HGB and increased hematocrit compared with admission level. NC group was the other patients. The endpoint was all-cause death or rehospitalization for cadiac reasons, with a follow-up duration of 2 years. Results: 304 patients in the Cohort expercienced HC. Patients with HC had a profile consistent with higher heart rate, higher eGFR levels, lower BNP levels at admission[(89.7±20.6)vs.(86.4±19.5)次/min,(62.6±23.7)vs.(56.8±22.5) mL·min-1·1.73 m-2, 1 753(1 073,2 507) vs. 1 882(1 132,2 554) ng/L,P<0.05], and longer length of stay, greater weight loss at discharge compared to the remainder of the cohort[(8.5±2.3)vs.(7.2±2.1)d,(2.8±0.2)vs.(1.9±0.1)kg, P<0.001]. In the follow-up 2 years, 115(37.8%) patients with HC and 203(46.8%) patients with NC result ed in all-cause death. Kaplan-Meier analysis indicated that patients with HC had a lower rate of death(P<0.05). Cox regression analysis revealed that age, history of hypertension, HC status were independent prognostic factors in AHF(HR=0.58,95%CI:0.39-0.82,P=0.017). Conclusions: Hemoconcentration status at discharge may serve as a valuable predictor of death or re-hospitalization within 2 years in patients with AHF.

关 键 词：红细胞压积 血红蛋白 急性心力衰竭 预后 

分 类 号：R54[医药卫生—心血管疾病]