减重对青年和中老年心力衰竭患者预后的影响  

Effect of weight loss on prognosis in young and middle-aged and elderly patients with heart failure

作　　者：何珊[1] 关晓楠[1] 张建军[1] HE Shan;GUAN Xiaonan;ZHANG Jianjun(Department of Cardiology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100043,China)

机构地区：[1]首都医科大学附属北京朝阳医院心内科,100043

出　　处：《心肺血管病杂志》2023年第3期232-236,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:比较减重对青年和中老年心力衰竭患者预后的影响。方法:回顾性分析2017年1月至2020年6月,于北京朝阳医院心脏中心住院,出院1年后体质量较基线水平下降≥5%的慢性心力衰竭患者,根据年龄分为青年组(≤45岁)和中老年组(>45岁),比较两组基线资料特点,随访观察第2年体质量变化情况以及有无主要心血管不良事件(MACE),包括心源性死亡以及心力衰竭再入院。结果:本研究共纳入217例,第2年仍维持体质量下降≥5%的患者165例,其中青年组31例,中老年组134例。青年组男性、BMI、舒张压、心率水平更高,更多合并睡眠呼吸暂停综合征,LVEF更低,中老年组合并冠心病、心房颤动、慢性肾功能不全比例高。随访发现,保持减重的青年心力衰竭患者MACE事件及心力衰竭再入院发生率更低(P<0.05),两组在死亡率上差异无统计学意义。多因素Logistic回归分析显示,年龄>45岁(OR=3.008,95%CI:1.107~8.172)、NT-proBNP(OR=4.512,95%CI:1.688~12.061)、缺血性心肌病(OR=2.459,95%CI:1.217~4.969)是影响减重心力衰竭患者预后的危险因素。结论:减重可以减少青年心力衰竭患者因心力衰竭再入院率,改善青年心力衰竭患者的预后。Objective:To compare the effect of weight loss on prognosis in young and middle-aged and elderly patients with heart failure.Methods:Patients hospitalized for heart failure with NYHA class II~Ⅳfrom January 2017 to June 2020 in Beijing Chaoyang Hospital with weight loss≥5%from baseline at one year after discharge were recruited in our study.Patients were divided into the young group(aged≤45)and the middle-aged and elderly group(aged>45years).Baseline characteristics were compared between the two groups.The change of weight at the second year and the incidence of major adverse cardiac events(MACE)including mortality and rehospitalization for heart failure were collected during follow up.Results:There were totally 217 patients involved in the study,among them,165 patients remained weight loss at the second year after discharge,including 31 patients in the young group and 134 patients in the middleaged and elderly group.The young group had more male and obstructive sleep apnea syndrome,higher BMI,diastolic pressure and heart rate,and lower left ventricular ejection fraction.Patients in the middle-aged and elderly group were more likely to have coronary artery disease, atrial fibrillation and renal dysfunction. Those who kept weight loss in the second year in the young group had lower incidence of MACE and rehospitalization for heart failure, there were no significant differences in mortality in the two groups. Multivariable Logistic regression analysis showed that age>45( OR=3.008, 95%CI :1.107-8.172), NT-proBNP(OR=4.512, 95%CI :1.688-12.061) and ischemic cardiomyopathy(OR=2.459, 95%CI :1.217-4.969) were independent risk factors for MACE. Conclusions: Weight loss was associated with lower rehospitalization for heart failure in the young patients. Young heart failure patients could benefit from weight loss.

关 键 词：心力衰竭 减重 青年 预后 

分 类 号：R54[医药卫生—心血管疾病]