老年射血分数保留的心力衰竭合并贫血患者心脏结构及功能分析  

Cardiac structure and function in elderly heart failure patients with preserved ejection fraction complicated with anemia

作　　者：朱剑 边素艳[1,2,3] 刘姗姗 王彬华[4] 徐洪丽 何昆仑[5] ZHU Jian;BIAN Su-Yan;LIU Shan-Shan;WANG Bin-Hua;XU Hong-Li;HE Kun-Lun(Department of Cardiology,Second Medical Center,Chinese PLA General Hospital,Beijing 100853,China;National Clinical Research Center for Geriatric Diseases,Chinese PLA General Hospital,Beijing 100853,China;Beijing Key Laboratory of Chronic Heart Failure Precision Medicine,Beijing 100853,China;Disaster Medical Research Center,Medical Innovation Research Division,Chinese PLA General Hospital,Beijing 100853,China;Big Data Research Center,Medical Innovation Research Division,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院第二医学中心心血管内科,北京100853 [2]中国人民解放军总医院国家老年疾病临床医学研究中心,北京100853 [3]慢性心衰精准医学北京市重点实验室,北京100853 [4]中国人民解放军总医院医学创新研究部灾害医学研究中心,北京100853 [5]中国人民解放军总医院医学创新研究部大数据研究中心,北京100853

出　　处：《中华老年多器官疾病杂志》2023年第1期19-23,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：工业和信息化部2020年产业技术基础公共服务平台项目(2020-0103-3-1)。

摘　　要：目的分析老年射血分数保留的心力衰竭(HFpEF)合并贫血患者的心脏结构及功能特点。方法选取2008年2月至2019年12月于中国人民解放军总医院第一医学中心住院的≥60岁的老年HFpEF患者2281例,根据是否合并贫血,分为贫血组(n=949)和对照组(n=1332)。分析2组患者的临床特征、心脏超声结构及功能差异。采用EmpowerStats统计软件(3.0版)和R软件进行数据分析。根据数据类型,组间比较分别采用独立样本t检验、Kruskal-Wallis H检验或χ^(2)检验。采用多元线性回归模型分析血红蛋白(HGB)的影响因素,以及HGB与心脏超声指标的相关性。结果老年HFpEF住院患者中41.6%(949/2281)合并贫血。贫血组男性[54.69%(519/949)和47.75%(636/1332)]、年龄[(74.79±7.99)和(73.40±7.72)年]、收缩压[(140.06±23.80)和(136.77±23.05)mmHg(1 mmHg=0.133 kPa)]、院内全因死亡率[3.58%(34/949)和1.50%(20/1332)]、空腹血糖[(7.68±3.35)和(7.02±3.38)mmol/L]、N末端B型利钠肽原(NT-proBNP)[3118.01(1137.21,8976.32)和1333.34(596.32,2777.11)ng/L]及肌钙蛋白T[0.04(0.02,0.08)和0.02(0.01,0.04)μg/L]显著高于对照组,体质量指数[(24.34±4.10)和(24.87±4.05)kg/m^(2)]、HGB[(9.37±1.65)和(13.32±1.45)g/dl]及估算肾小球滤过率[38.85(13.98,73.98)和76.26(57.79,95.87)ml/(min·1.73m^(2))]显著低于对照组,差异均有统计学意义(均P<0.05)。2组间纽约心脏病协会心功能分级和慢性肾脏病(CKD)分期比较,差异均有统计学意义(均P<0.05)。心脏超声结果显示,与对照组相比,贫血组左心扩大更明显,表现为左心房前后径[(41.43±8.13)和(40.64±7.62)mm]、左心房容积指数[29.82(22.55,38.80)和28.38(20.55,38.96)ml/m^(2)]、左心室收缩末期内径[(32.63±4.48)和(31.64±4.89)mm]、左心室舒张末期内径[(46.87±5.78)和(45.75±6.47)mm]、左心室收缩末期容量[(44.98±23.97)和(41.15±15.75)ml]及左心室舒张末期容量[(103.69±30.07)和(97.36±31.03)ml]显著增大;左心室肥厚更显著,表现�Objective To analyze the characteristics of cardiac structure and function in elderly heart failure patients with preserved ejection fraction(HFpEF)complicated with anemia.Methods A total of 2281 elderly HFpEF patients≥60 years old hospitalized in the First Medical Center of Chinese PLA General Hospital from February 2008 to December 2019 were enrolled and divided into anemia group(n=949)and control group(n=1332)according to whether they were accompanied by anemia.The clinical characteristics,cardiac ultrasonic structure and function were analyzed and compared between the 2 groups.The data were analyzed with EmpowerStats statistical software(version 3.0)and R software.According to the data type,independent sample t-test,Kruskal Wallis H test or Chi-square test was used for comparison between groups.Multivariate linear regression model was employed to analyze the influencing factors of hemoglobin(HGB)and the correlation of HGB with cardiac ultrasound indexes.Results The prevalence of anemia was 41.6%(949/2281)in the elderly HFpEF inpatients.The patients of the anemia group had significantly higher ratio of males[54.69%(519/949)vs 47.75%(636/1332)],older age[(74.79±7.99)vs(73.40±7.72)years],higher systolic blood pressure[(140.06±23.80)vs(136.77±23.05)mmHg(1 mmHg=0.133 kPa)],increased hospital all-cause mortality[3.58%(34/949)vs 1.50%(20/1332)],and higher levels of fasting blood glucose[(7.68±3.35)vs(7.02±3.38)mmol/L],N-terminal pro B-type natriuretic peptide[NT-proBNP,3118.01(1137.21,8976.32)vs 1333.34(596.32,2777.11)ng/L]and troponin T[0.04(0.02,0.08)vs 0.02(0.01,0.04)μg/L],but lower body mass index[(24.34±4.10)vs(24.87±4.05)kg/m^(2)],HGB level[(9.37±1.65)vs(13.32±1.45)g/dl]and estimated glomerular filtration rate[38.85(13.98,73.98)vs 76.26(57.79,95.87)ml/(min·1.73m^(2))]when compared with the patients in the control group(all P<0.05).There were statistical differences between the 2 groups in heart function classification and chronic kidney disease(CKD)stage(both P<0.05).Cardiac ultrasound results sh

关 键 词：老年人 射血分数保留的心力衰竭 贫血 心脏结构重构 左心室舒张功能 

分 类 号：R541[医药卫生—心血管疾病]