射血分数降低的心力衰竭患者预后营养指数与主要心血管不良事件的关系  

Association between prognostic nutritional index and major adverse cardiovascular events of heart failure with reduced eiection fraction

作　　者：杨龙 祖丽护玛·色依提 沈霞 张雪鹤 拜合热木江·阿布都艾尼 努尔艾合麦提·加马力 阿布肚沙拉木·卡斯木江 托呼塔生·德吉特 高晓明 单雪峰[4] YANG Long;Zulihuma SEYITI;SHEN Xia;ZHANG Xuehe;Baiheremujiang ABUDUAINI;Nueraihemaiti JIAMALI;Abudushalamu KASIMUJIANG;Tuohutasheng DEJITE;GAO Xiaoming;SHAN Xuefeng(College of Pediatrics,Xinjiang Medical University,Urumqi,Xinjiang Uygur Autonomous Region 830054,China;Wuri Medical College,Jiangnan University,Wuri,Jiangsu 214122,China;Xinjiang Medical Animal Model Research Laboratory,Urumqi,Xinjiang Uygur Autonomous Region 830054,China;Department of Pediatric Cardiothoracic Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumgi,Xinjiang Uygur Autonomous Region 830054,China)

机构地区：[1]新疆医科大学儿科学院,新疆维吾尔自治区乌鲁木齐830054 [2]江南大学无锡医学院,江苏无锡214122 [3]新疆医学动物模型研究实验室,新疆维吾尔自治区乌鲁木齐830054 [4]新疆医科大学第一附属医院小儿心胸外科,新疆维吾尔自治区乌鲁木齐830054

出　　处：《中华实用诊断与治疗杂志》2023年第8期762-766,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(U1903212);省部共建中亚高发病成因与防治国家重点实验室开放课题(SKL-HIDCA-2022-XXG1,SKL-HIDCA-2021-XXG1);新疆维吾尔自治区重点实验室开放课题(2020D04027)。

摘　　要：目的分析预后营养指数(PNI)与射血分数降低的心力衰竭(HFrEF)患者发生主要心血管不良事件(MACE)风险的关系,探讨PNI预测HFrEF患者发生MACE的价值。方法2010年1月—2017年12月新疆医科大学第一附属医院诊治HFrEF患者1011例,记录年龄、吸烟史、中性粒细胞计数、淋巴细胞计数、血清白蛋白、空腹血糖、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、血肌酐水平等,计算PNI、老年营养风险指数(GNRI)。根据PNI四分位数将1011例患者分为PNI Q1组(20.0~41.4)253例、PNI Q2组(>41.4~45.7)253例、PNI Q3组(>45.7~50.0)252例和PNI Q4组(>50.0~72.9)253例。随访5年,记录MACE(包括心源性死亡、急性心肌梗死、心源性休克、脑卒中、消化道出血、恶性心律失常及心力衰竭再入院)发生情况。绘制Kaplan-Meier生存曲线,无MACE生存率比较采用log-rank检验;采用多因素Cox回归分析HFrEF患者发生MACE的影响因素;绘制ROC曲线,评估PNI、GNRI预测HFrEF患者发生MACE的效能。结果PNI Q4组年龄[59.0(51.0,67.0)岁]小于PNI Q1组[69.0(61.0,76.0)岁](U=107.727,P<0.001),舒张压[73.0(65.0,80.0)mmHg]、中性粒细胞计数[4.58(3.58,5.48)×10^(9)/L]、血肌酐[80.3(69.0,98.0)μmol/L]均低于PNI Q1组[74.0(66.0,81.0)mmHg、4.92(3.79,6.52)×10^(9)/L、96.5(73.8,123.6)μmol/L](P<0.05),吸烟比率(53.8%)、体质量指数[26.8(24.1,29.2)kg/m^(2)]、PNI[53.2(51.4,55.6)]、GNRI[104.3(101.6,107.8)]、淋巴细胞计数[2.15(1.82,2.61)×10^(9)/L]、白蛋白[42.1(40.3,44.6)g/L]、三酰甘油[1.38(1.02,2.01)mmol/L]、低密度脂蛋白胆固醇[2.17(1.58,2.81)mmol/L]、高密度脂蛋白胆固醇[0.92(0.78,1.10)mmol/L]均高于PNI Q1组[40.7%、24.2(22.0,26.4)kg/m^(2)、38.2(35.5,40.2)、88.0(84.4,91.0)、1.18(0.87,1.47)×10^(9)/L、31.8(29.6,33.8)g/L、0.95(0.76,1.26)mmol/L、1.96(1.62,2.50)mmol/L、0.84(0.69,1.02)mmol/L](P<0.05)。1011例患者中位随访时间38个月,512例发生MACE(50.6%);PNI Q1组、PNI Q2组、PNI Q3组、PNI Q4�Objective To analyze the correlation between the prognostic nutritional index(PNI)and the risk of major adverse cardiovascular events(MACE)in patients with heart failure and reduced ejection fraction(HFrEF),and to investigate the value of PNI to the prediction of MACE in HFrEF patients.Methods From January 2010 to December2017,1011 patients with HFrEF were diagnosed and treated in the First Affiliated Hospital of Xinjiang Medical University.The age,smoking history,neutrophil count,lymphocyte count,serum albumin,fasting plasma glucose,triacylglycerol,low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HLD-C),and blood creatinine levels were recorded to calculate the PNI and geriatric nutritional risk index(GNRI).Based on the PNI quartiles,these 1011 patients were divided into 253 patients with PNI of 20.0-41.4(PNI Q1 group),253 patients with PNI of>41.4-45.7(PNI Q2 group),252 patients with PNI of>45.7-50.0(PNI Q3 group),and 253 patients with PNI of>50.0-72.9(PNI Q4 group).The patients were followed up for 5 years to record the incidences of MACE including cardiac death,acute myocardial infarction,cardiogenic shock,stroke,gastrointestinal hemorrhage,malignant arrhythmia,and readmission due to heart failure.Kaplan-Meier survival curves were plotted,and log-rank test was done to compare the MACE-free survival rate.Multivariate Cox regression analysis was conducted to identify the influencing factors of MACE in patients with HFrEF.ROC curves were plotted to evaluate the efficiencies of PNI and GNRI on predicting MACE.Results The patients were younger in PNI Q4 group[59.0(51.0,67.0)years]than in PNI Q1 group[69.0(61.0,76.0)years](U=107.727,P<0.001).The diastolic blood pressure,neutrophil count and blood creatinine were lower in PNI Q4 group[73.0(65.0,80.0)mmHg,4.58(3.58,5.48)×10^(9)/L,80.3(69.0,98.0)μmol/L]than those in PNI Q1 group[74.0(66.0,81.0)mmHg,4.92(3.79,6.52)×10^(9)/L,96.5(73.8,123.6)μmol/L](P<0.05),and the smoking rate,body mass index,PNI,GNRI,lymphocyte count,albumin,triacylgl

关 键 词：射血分数降低的心力衰竭 预后营养指数 主要心血管不良事件 

分 类 号：R541.6[医药卫生—心血管疾病]