衰弱对植入心脏再同步治疗除颤器的慢性心力衰竭患者预后的影响  

The impact of frailty on the prognosis of chronic heart failure patients treated with cardiac resynchronization therapy defibrillator implantation

作　　者：高亮[1] 吕华胜 汤宝鹏[1] 周贤惠[1] 程新春[2] 史有全 李耀东[1] 张疆华[1] 邢强[1] 祖克拉·吐尔洪 芦颜美[1] Gao Liang;Lyu Huasheng;Tang Baopeng;Zhou Xianhui;Cheng Xinchun;Shi Youquan;Li Yaodong;Zhang Jianghua;Xing Qiang;Zukela Tuerhong;Lu Yanmei(Department of Pacing Electrophysiology,the First Affiliated Hospital of Xinjiang Medical University,Urumqi830000,China;The Geriatric Medicine Center of Xinjiang Uygur Autonomous Region People's Hospital,Urumqi830000,China;Department of Cardiology,Third People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi830000,China)

机构地区：[1]新疆医科大学第一附属医院心脏中心起搏电生理科,乌鲁木齐830000 [2]新疆维吾尔自治区人民医院老年医学中心,乌鲁木齐830000 [3]新疆维吾尔自治区第三人民医院心内一科,乌鲁木齐830000

出　　处：《中华内科杂志》2025年第1期45-51,共7页Chinese Journal of Internal Medicine

基　　金：新疆维吾尔自治区天山英才-青年拔尖科技人才项目(2022TSYCCX0101);新疆维吾尔自治区自然科学基金面上项目(2022D01C635)。

摘　　要：目的本研究旨在评估接受心脏再同步治疗除颤器(cardiac resynchronization therapy defibrillator,CRT-D)治疗的心衰患者的衰弱状态,进而探索衰弱在这类患者接受器械治疗后全因死亡以及因心衰再次入院事件发生过程中的预测作用。方法回顾性纳入2020年6月至2024年6月就诊于新疆医科大学第一附属医院行CRT-D治疗的心衰患者374例,根据Tilburg衰弱评估量表结果,将其分为衰弱组175例(46.8%)及非衰弱组199例(53.2%),对两组间基线资料进行比较,采用Cox回归分析和Kaplan-Meier曲线进行生存分析。P<0.05为差异有统计学意义。结果共纳入374例患者,年龄25~93(68±11)岁,男性患者273例(73.0%)、女性患者101例(27.0%),衰弱组175例(46.8%),非衰弱组199例(53.2%)。中位随访时间23(5,45)个月,共35例(9.4%)患者发生全因死亡事件,其中衰弱组30例(17.1%),非衰弱组5例(2.5%);共有174例(46.5%)患者发生因心衰再入院事件,其中衰弱组122例(70.1%),非衰弱组52例(29.9%)。Cox分析显示,衰弱是CRT-D心衰患者全因死亡事件(HR=21.25,95%CI 3.99~113.30,P<0.001)和因心衰再入院事件(HR=2.52,95%CI 1.73~3.68,P<0.001)发生的预测因素。log-rank检验显示,衰弱组患者的生存率显著低于非衰弱组患者(HR=7.22,95%CI 2.80~18.60,P<0.001),而衰弱组患者发生因心衰再入院事件的风险显著高于非衰弱组(HR=2.75,95%CI 1.98~3.81,P<0.001)。结论衰弱是CRT-D心衰患者术后发生全因死亡和因心衰再入院事件发生的独立预测因素。Objective The aim of this study was to assess the frailty status of patients with heart failure undergoing CRT-D and then explore the predictive value of frailty for all-cause mortality and heart failure-related readmissions in these patients.MethodsWe retrospectively included 374 patients with chronic heart failure who underwent CRT-D treatment at the First Affiliated Hospital of Xinjiang Medical University between June 2020 and June 2024.Based on the Tilburg Debilitation Assessment Scale,175 patients(46.8%)were classified as frail while 199(53.2%)were classified as non-frail.The baseline data between the two groups was compared using Cox regression analysis and Kaplan-Meier curves were used for survival analysis.P-values of<0.05 indicated statistically significant differences.ResultsA total of 374 patients aged 25-93(68±11)years were enrolled in this study,101(27.0%)of which were female.Among these,175(46.8%)were categorized as frail,and 199(53.2%)were classified as non-frail.Over a median follow-up time of 23(5,45)months,35(9.4%)patients experienced all-cause mortality,with 30(17.1%)deaths occurring in the frail group and 5(2.5%)in the non-frail group;meanwhile,readmission events due to heart failure occurred in a total of 174(46.5%)patients,including 122(70.1%)in the frail group,and 52(29.9%)in the non-frail group.Cox analysis showed that frailty was a significant determinant of all-cause mortality(HR=21.25,95%CI 3.99-113.30,P<0.001)and readmission among heart failure patients receiving CRT-D(HR=2.52,95%CI 1.73-3.68,P<0.001).Log-rank tests showed that the survival rate of patients in the frail group was significantly lower than that of patients in the non-frail group(HR=7.22,95%CI 2.80-18.60,P<0.001)and the risk of readmission events due to heart failure was significantly higher among patients in the frail group than among those in the non-frail group(HR=2.75,95%CI 1.98-3.81,P<0.001).ConclusionsFrailty is an independent predictor of postoperative all-cause mortality and the occurrence of heart failure-relate

关 键 词：心力衰竭 预后 心脏再同步化治疗设备 衰弱 

分 类 号：R541.6[医药卫生—心血管疾病]