血压波动对重度主动脉瓣狭窄患者不良预后的影响  

The influence of blood pressure fluctuation on poor prognosis in patients with severe aortic stenosis

作　　者：杨雪圆 冯超[3,4] 冯津萍 YANG Xueyuan;FENG Chao;FENG Jinping(Department of Cardiology,Chest Hospital,Tianjin University,Tianjin 300222,China;Graduate School of Tianjin Medical University;Department of CICU,Tianjin Chest Hospital;Tianjin Key Laboratory of Cardiovascular Emergency and Critical Care,Tianjin Municipal Science and Technology Bureau)

机构地区：[1]天津大学胸科医院心内科,300222 [2]天津医科大学研究生院 [3]天津市胸科医院CICU [4]天津市心血管急危重症重点实验室

出　　处：《天津医药》2023年第10期1110-1116,共7页Tianjin Medical Journal

基　　金：天津市科技计划项目(21JCZDJC00600);天津市医学重点学科(专科)建设项目。

摘　　要：目的分析重度主动脉瓣狭窄(AS)不良预后的危险因素,评估血压及血压波动对重度AS不良预后的影响。方法收集慢性心力衰竭(CHF)急性失代偿患者的临床资料并根据是否合并AS分为AS组和非主动脉瓣狭窄(NAS)组,记录患者基线临床资料、随访结果、入院后连续3 d及出院前2 d血压监测值,计算平均动脉压(MAP)、收缩压差(ΔSBP)及舒张压差(ΔDBP)。主要终点事件为全因死亡和(或)因心力衰竭再入院的复合终点,次要终点事件为心源性死亡。采用Kaplan-Meier生存曲线比较2组主要和次要终点事件发生率差异;采用单因素及多因素Cox回归模型分析AS患者不良预后的影响因素。进一步根据AS患者是否合并高血压以及ΔSBP四分位数分别进行亚组分析,比较组间终点事件发生情况及结局差异。结果纳入患者91例,其中AS组50例,NAS组41例。与NAS组比较,AS组年龄更大,合并吸烟史、糖尿病史及入院时有双下肢水肿症状比例更高,白蛋白水平更低,肺动脉收缩压更高(均P<0.05)。Kaplan-Meier结果表明,AS组主要及次要终点事件的发生率高于NAS组(P<0.05)。Cox回归结果显示,高龄、合并高血压、ΔSBP升高以及中性粒细胞百分比(NE)升高是AS患者发生主要终点事件的独立危险因素;高龄、ΔSBP和ΔDBP升高是次要终点事件的独立危险因素(均P<0.05)。亚组分析结果显示,AS合并高血压亚组主要终点事件发生率高于非高血压亚组(P<0.05);ΔSBP越大,AS组主要终点事件发生率越高(P<0.001)。结论高血压、ΔSBP升高及高龄是AS预后不良的独立危险因素。AS患者生存率更低,血压波动越大,AS患者生存率越低,预后越差。Objective To analyze risk factors for the poor prognosis of severe aortic stenosis(AS),and to evaluate the influence of blood pressure and blood pressure fluctuation on the poor prognosis of severe AS.Methods Clinical data of patients with acute decompensation of chronic heart failure(CHF)admitted to the Cardiac Intensive Care Unit of Tianjin Chest Hospital from December 2018 to March 2022 were collected.Patients were divided into the AS group and the non NAS group according to aortic stenosis lesions.Baseline clinical data,follow-up results,blood pressure for consecutive 3 days after admission and blood pressure monitoring values for 2 days before discharge were collected,and indexes such as mean arterial pressure(MAP),systolic pressure difference(ΔSBP)and diastolic pressure difference(ΔDBP)were calculated.The primary endpoint event was a composite endpoint of rehospitalization and/or all-cause death due to heart failure,and the secondary endpoint event was cardiogenic death.The Kaplan-Meier survival curve was used to compare the survival differences between the two groups.Univariate and multivariate Cox regression models were used to analyze prognostic factors of aortic stenosis in patients with AS.Further subgroup analysis was conducted according to whether the AS group was complicated with hypertension and theΔSBP quartile to compare the occurrence of end events and outcome differences between groups.Results Ninety-one patients were included,including 50 in the AS group and 41 in the NAS group.Compared with the NAS group,the AS group was older,and had a higher proportion of smoking history,diabetes history,and lower extremity edema symptoms on admission,lower albumin level,and higher pulmonary artery systolic blood pressure(P<0.05).Kaplan-Meier results showed that the incidence of primary(P=0.030)and secondary(P=0.037)endpoint events were higher in the AS group than that in the NAS group.Cox regression results showed that old age,combined hypertension,elevatedΔSBP,and elevated NE were independent risk fac

关 键 词：主动脉瓣狭窄 高血压 预后 危险因素 血压 

分 类 号：R542.52[医药卫生—心血管疾病]