不同肾功能水平老年急性心力衰竭患者左西孟旦疗效的真实世界研究  

The efficacy of levosimendan in elderly patients with acute heart failure at different levels of renal function:a real-world study

作　　者：肖迅[1] 张湘瑜[1] 罗晓琴 Xiao Xun;Zhang Xiangyu;Luo Xiaoqin(Department of Geriatrics,the Second Xiangya Hospital of Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院老年医学科,长沙410011

出　　处：《中华老年医学杂志》2025年第3期303-310,共8页Chinese Journal of Geriatrics

基　　金：湖南省保健专项资金科研课题(B2023-03)。

摘　　要：目的基于真实世界数据,探讨左西孟旦在不同肾功能水平老年急性心力衰竭患者中的疗效。方法本研究为一项回顾性队列研究,纳入2015年1月至2022年12月在中南大学湘雅二医院住院期间使用过正性肌力药物的老年急性心力衰竭患者699例,中位年龄71(66,77)岁,男性占61.9%。包括使用非左西孟旦正性肌力药物组(171例)和左西孟旦组(528例),收集住院期间的基线临床资料。主要观察指标包括治疗后N末端B型利钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)水平下降、30 d内和1年内死亡,次要观察指标包括住院天数和院内死亡。根据患者用药前的肾小球滤过率估计值(estimated glomerular filtration rate,eGFR)水平,将其分为eGFR≥60 ml·min^(-1)·1.73(m^(-1))^(2)的患者和eGFR 15~<60 ml·min^(-1)·1.73(m^(-1))^(2)的患者。在不同肾功能水平的患者中,分别采用双重稳健方法分析接受左西孟旦治疗对心力衰竭改善和临床预后的影响。结果与非左西孟旦正性肌力药物组相比,左西孟旦治疗组NT-proBNP水平下降的比例明显增加(31.0%比47.0%,P<0.001),但住院天数、院内死亡率、30 d内和1年死亡率差异无统计学意义(P均>0.05)。经双重稳健方法校正后,左西孟旦显著降低了NT-proBNP水平(OR=1.553,95%CI:1.225~1.972,P<0.001),但对30 d内和1年内死亡率无显著改善。在eGFR 15~>60 ml·min^(-1)·1.73(m^(-1))^(2)的患者中,左西孟旦可显著降低NT-proBNP水平(OR=1.797,95%CI:1.308~2.481,P<0.001),降低30 d内死亡率(HR=0.536,95%CI:0.292~0.986,P=0.045)。在eGFR≥60 ml·min^(-1)·1.73(m^(-1))^(2)的患者中,左西孟旦可显著降低NT-proBNP水平(OR=1.965,95%CI:1.325~2.933,P<0.001),但对30 d内死亡率无显著改善。对于不同肾功能水平的患者,左西孟旦对1年内死亡率均无显著影响(均P>0.05)。结论左西孟旦可显著改善不同肾功能水平老年急性心力衰竭患者的心功能,且eGFR 15~<60 ml·min^(-1)·1.73(m^(-1))^ObjectiveThis study aims to evaluate the efficacy of levosimendan in elderly patients with acute heart failure across varying levels of renal function,utilizing real-world data.MethodsWe conducted a retrospective cohort study involving 699 elderly patients with acute heart failure who were hospitalized at the Second Xiangya Hospital of Central South University and received positive inotropic drugs between January 2015 and December 2022.The median age of the participants was 71 years(interquartile range,66 to 77),with 61.9%being male.Among these patients,171 received non-levosimendan positive inotropic drugs(non-levosimendan group),while 528 were treated with levosimendan(levosimendan group).Baseline clinical data collected during hospitalization were analyzed.The primary outcomes assessed included the reduction in N-terminal pro-brain natriuretic peptide(NT-proBNP)levels following treatment,as well as mortality rates within 30 days and one year.Secondary outcomes encompassed the length of hospital stay and in-hospital mortality.Patients were categorized based on their estimated glomerular filtration rate(eGFR)prior to treatment,with groups defined as those with eGFR≥60 ml·min^(-1)·1.73(m^(-1))^(2) and those with eGFR between 15 and<60 ml·min^(-1)·1.73(m^(-1))^(2).The impact of levosimendan treatment on heart failure improvement and clinical prognosis was analyzed using a double robust method,which accounted for patients with varying levels of renal function.ResultsIn comparison to the non-levosimendan group,a significantly higher proportion of patients in the levosimendan group exhibited decreased NT-proBNP levels(31.0%vs.47.0%,P<0.001).However,there were no significant differences regarding the length of hospital stay,in-hospital mortality,or mortality rates at 30 days and 1 year(all P>0.05).After applying the double robust method for adjustment,levosimendan was shown to significantly reduce NT-proBNP levels(OR=1.553,95%CI:1.225^(-1).972,P<0.001),although it did not result in a significant improvement in 3

关 键 词：左西孟旦 心力衰竭 肾功能 双重稳健 

分 类 号：R54[医药卫生—心血管疾病]