机构地区:[1]北京医院心内科国家老年医学中心中国医学科学院老年医学研究院,100730
出 处:《中华全科医师杂志》2021年第10期1059-1065,共7页Chinese Journal of General Practitioners
基 金:中国医学科学院医学与健康科技创新工程(2018-12M-1-002);北京医院院级课题(bj-2018-011)。
摘 要:目的总结新发急性心力衰竭(心衰)患者的临床特点,分析影响新发急性心衰和急性失代偿性慢性心衰(ADCHF)患者预后的危险因素。方法回顾性纳入2009年1月1日至2017年12月31日因心衰在北京医院住院并有随访记录的患者,根据心衰持续时间将患者分为新发急性心衰组(心衰持续时间<1个月)和ADCHF组(心衰持续时间≥1个月),收集临床资料,记录终点事件(全因死亡和心血管死亡)。采用Kaplan-Meier法绘制生存曲线,用log-rank法比较不同组间生存差异,采用多因素Cox回归模型分析两组患者终点事件的独立危险因素。结果共纳入心衰患者562例,其中新发急性心衰组292例(52.0%),ADCHF组270例(48.0%)。新发急性心衰组中合并冠心病、急性心肌梗死的患者比例较高,舒张压较高、肌钙蛋白I水平较高(χ^(2)=12.999、15.018,t=-2.088,Z=-2.727;均P<0.05)。ADCHF组患者中NYHA分级Ⅲ~Ⅳ级的患者比例较高,合并心房颤动比例较高,左心室、左心房内径较大,合并肺动脉高压患者比例较高(χ^(2)=16.565、15.688,t=2.714、5.029,χ^(2)=15.274;均P<0.05)。随访28(14,60)个月,发生全因死亡205例(36.5%),心血管死亡132例(23.5%)。新发急性心衰组全因死亡率[33.2%(97/292)比40.0%(108/270),log-rankP=0.010]和心血管死亡率[18.8%(55/292)比28.5%(77/270),log-rankP=0.001]均低于ADCHF组。多因素Cox回归分析结果显示低体重指数、血红蛋白降低、较慢的静息心率、左心房扩大、节段性室壁运动异常是新发急性心衰患者不良预后的独立危险因素,与ADCHF患者有所不同。结论新发急性心衰患者中冠心病比例较高,不良预后与低体重指数、血红蛋白降低、急性心肌梗死相关,需早期识别基础病,积极规范化治疗,避免心功能恶化和再入院。Objective To analyze the clinical characteristics and prognostic factors in patients with new-onset acute heart failure(AHF)and acutely decompensated chronic heart failure(ADCHF).Methods Patients with heart failure(HF)admitted to Beijing Hospital during January 2009 to December 2017 with follow-up records were retrospectively enrolled.According to the duration of heart failure,the patients were divided into new-onset AHF group(duration of HF<1 month)and ADCHF group(duration of HF≥1 month).Clinical data were collected and endpoint events(all-cause death and cardiovascular death)were recorded.The Kaplan-Meier survival curve and the log-rank method was used to compare survival between different groups.The multivariate Cox regression model was used to analyze the independent risk factors for the end-point events in patients with new-onset AHF and ADCHF.Results The study enrolled 562 patients,292(52.0%)with new-onset AHF and 270(48.0%)with ADCHF.Patients with new-onset AHF were more likely to have coronary heart disease,acute myocardial infarction,higher diastolic blood pressure and higher troponin I levels(χ^(2)=12.999,15.018,t=-2.088,Z=-2.727;all P<0.05).Patients with ADCHF were more likely to have poor cardiac function,atrial fibrillation,larger left ventricle and left atrium diameter,higher proportion of patients with pulmonary hypertension(χ^(2)=16.565,15.688,t=2.714,5.029,χ^(2)=15.274;all P<0.05).There were 205(36.5%)all-cause deaths and 132(23.5%)cardiovascular deaths during 28(14,60)months of follow-up.All-cause mortality rate[33.2%(97/292)vs.40.0%(108/270),log-rank P=0.010]and cardiovascular mortality rate[18.8%(55/292)vs.28.5%(77/270),log-rank P=0.001]were significantly lower in patients with new-onset AHF than those in ADCHF group.Multivariate Cox regression analysis showed that low body mass index(BMI),reduced hemoglobin,reduced resting heart rate,enlarged left atrium,and segmental wall motion abnormalities were independent risk factors for poor prognosis in new-onset AHF patients.It was different wit
分 类 号:R541.6[医药卫生—心血管疾病]
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