青年与中老年心力衰竭患者的临床特点及预后研究  

Clinical characteristics and prognosis in young and middle-aged and elderly patients with heart failure

作　　者：何珊[1] 关晓楠[1] 马桂伶[1] 张建军[1] HE Shan;GUAN Xiaonan;MA Guiling;ZHANG Jianjun(Department of Cardiology,Beijing Chao-yang Hospital,Capital Medical University,Beijing China 100043)

机构地区：[1]首都医科大学附属北京朝阳医院心内科,北京100043

出　　处：《中国临床医生杂志》2023年第1期24-27,共4页Chinese Journal For Clinicians

摘　　要：目的观察青年与中老年心力衰竭(心衰)患者的临床特点、心脏超声指标、实验室化验、临床用药及预后,并分析影响预后的因素。方法回顾性分析2019年1月至2020年7月于首都医科大学附属北京朝阳医院心脏中心住院的心功能Ⅱ~Ⅳ级心力衰竭患者348例,按照年龄分为青年组62例(≤50岁)和中老年组286例(>50岁),收集一般临床资料、实验室化验、心脏超声指标、临床治疗情况。观察两组患者主要心血管不良事件的发生率,包括心源性死亡及心衰再入院。应用Kaplan-Meier(K-M)法绘制生存曲线,应用多因素logistic回归分析影响心血管不良事件的危险因素。结果青年组男性、高血压性心脏病、扩张性心肌病、肥胖性心肌病及心肌炎后心衰、射血分数减低性心衰、合并睡眠呼吸暂停综合征比例高于中老年组,体重指数、心率、舒张压高于中老年组(P<0.05)。青年组射血分数更低,左心室舒张末期及收缩末期内径更大,应用β受体阻滞剂、螺内酯及血管紧张素受体脑啡肽酶抑制剂比例高于中老年组(P<0.05)。K-M曲线显示,青年组24个月时主要心血管不良事件发生率及心衰再入院率更低(P<0.05),两组间死亡率无差异。多因素logistic回归分析显示,男性(OR=1.891,95%CI 1.173~3.049)、缺血性心肌病(OR=2.415,95%CI 1.498~3.895)、肌酐>150μmol/L(OR=1.981,95%CI 1.018~3.855)是影响心衰预后的独立危险因素。结论青年心衰患者男性、超重比例高,合并症相对少,心功能受损严重,但预后相对较好。男性、缺血性心肌病、肌酐>150μmol/L是影响心衰预后的独立危险因素。Objective This study aims to describe clinical,echocardiographic and laboratory characteristics,medication and prognosis in young and middle-aged and elderly patients with heart failure.Method Patients hospitalized for heart failure with NYHA class II~Ⅳfrom January 2019 to July 2020 in Beijing Chaoyang Hospital were categorized as the young group(n=62,aged≤50)and the middle-aged and elderly group(n=286,aged>50).Clinical baseline characteristics,echocardiographic measurements,laboratory tests and medical treatment were collected during hospitalization.The incidence of major cardiac adverse events(MACE)including cardiac death and rehospitalization for heart failure were compared between the two groups by multivariable logistic regression analysis.Result The young group had more male and a higher prevalence of dilated cardiomyopathy,hypertensive heart disease,obesity cardiomyopathy,myocarditis,heart failure with reduced ejection fraction and obstructive sleep apnea syndrome,meanwhile the level of body mass index,heart rate and diastolic pressure were higher than the middle-aged and elderly group.The young group had a lower ejection fraction and a higher left ventricular diastolic and systolic end-stage diameter than the middle-aged and elderly group.The use ofβblockers,spironolactone and angiotensin receptor neprilysin inhibitor were more frequent in the young group(P<0.05).The incidence of MACE and rehospitalization with heart failure were lower in the young group(P<0.05).Multivariable logistic regression analysis showed that male(OR=1.891,95%CI 1.173~3.049),ischemic cardiomyopathy(OR=1.891,95%CI 1.173~3.049)and creatinine>150μmol/L(OR=1.981,95%CI 1.018~3.855)were independent risk factors for MACE.Conclusion Young heart failure patients had a high proportion of male and overweight,few complications,and severe cardiac dysfunction,while the prognosis was better than the middle-aged and elderly patients.Male,ischemic cardiomyopathy and creatinine>150μmol/L were independent risk factors for heart failure prognos

关 键 词：心力衰竭 预后 青年 心力衰竭再入院 

分 类 号：R541.6[医药卫生—心血管疾病]