住院射血分数中间范围的心力衰竭患者的临床特点和预后分析

发布时间：2018-04-03 18:13

  本文选题：射血分数保留的心力衰竭　切入点：射血分数中间范围值的心力衰竭　出处：《郑州大学》2017年硕士论文

【摘要】：目的回顾性分析射血分数中间范围的心力衰竭(heart failure with mid-range left ventricular ejection fraction,HFmr EF)与射血分数保留的心力衰竭(heart failure with preserved left ventricular ejection fraction,HFp EF)、射血分数降低的心力衰竭(heart failure with reduced ejection fraction,HFr EF)患者临床特征和影响预后因素的差异,加深我们对HFmr EF的理解,为制定针对HFmr EF患者的预防策略提供一定的参考依据。方法收集2014年1月至2015年12月于河南省人民医院心内科住院的心力衰竭患者620例,最终符合纳入与排除标准的心衰患者共560例作为研究对象。根据LVEF值,将研究对象分为HFp EF(LVEF≥50%)、HFmr EF(40%≤LVEF≤49%)和HFr EF(LVEF40%),记录患者的基本信息、临床表现、超声心动图、动态心电图、临床用药等并于2017年1月至2017年2月通过电话进行随访,研究终点为全因死亡。分析比较HFp EF、HFmr EF和HFr EF三组患者性别、年龄、心脏结构与功能,血生化指标和预后因素的差异。数据处理用SPSS17.0统计学软件,应用W检验做正态性检验,计量资料服从正态分布或近似正态分布的以x±s表示;符合正态分布,且方差齐时,则三组间的比较应用单因素方差分析,再进行组内两两比较,两组间的比较采用LSD检验;不符合正态分布,且方差不齐时,采用秩和检验(Kmskal-Wallis检验);计数资料懫用百分率表示,组间比较采用χ2检验。生存分析采用Kaplan—Meier生存曲线,多因素分析采用COX比例风险回归模型。当P〈0.05时,为差异有统计学意义。计数资料三组间的两两比较,因仅进行HFmr EF组与HFr EF组的比较和HFmr EF组与HFp EF组的比较,所以检验水准为α=0.025。结果本研究纳入560例心力衰竭患者,其中男性326例(58%),女性234例(42%),平均年龄61±14,HFr EF患者274例(49%)、HFmr EF患者129例(23%)、HFp EF患者157例(28%)。560例患者中随访到509例,失访51例,失访率9%,中位随访时间为22(1-45)个月,其中共有79例患者死亡。(1)HFmr EF组与HFr EF组相比,HFmr EF组女性、糖尿病、贫血所占比例较大,NYHA IV级、扩张型心肌病所占比例较小(P0.025),入院收缩压较高,入院心率较慢(P0.05);HFmr EF组与HFp EF组相比,HFmr EF组年龄、入院收缩压较小(P0.05),冠心病、扩张型心肌病所占比例较大,心房颤动所占比例较小(P0.025);(2)实验室检查方面,相对于HFr EF组,HFmr EF组在红细胞数目、血红蛋白、总胆红素、血尿酸、NT-pro BNP方面水平较低(P0.05);相对于HFp EF组,HFmr EF组红细胞数目、谷丙转氨酶水平较高(P0.05)。(3)HFmr EF组与HFr EF组相比,HFmr EF组左房内径、左室舒末内径、右室内径较小(P0.05),肺动脉高压、室壁运动弥漫性减弱所占比例较小,室壁运动节段性异常所占比例较大(P0.025);相对于HFp EF组,HFmr EF组左室舒末内径较大(P0.05),室壁运动弥漫性减弱所占比例较大(P0.025)。(4)相对于HFr EF组,HFmr EF组氯吡格雷、他汀类药物使用率高,地高辛、螺内酯的使用率低(P0.025);相对于HFp EF组,HFmr EF组地高辛的使用率高,钙离子拮抗剂(CCB)的使用率低(P0.025)。(5)预后方面,三组患者预后未见明显差异(P=0.913)。(6)三组患者全因死亡的危险因子不同:冠心病、低血钠、心房颤动、未应用β受体阻滞剂是HFr EF全因死亡的独立危险因子(P0.05);HFmr EF全因死亡的独立危险因子:冠心病、左室舒末内径、贫血(P0.05);HFp EF全因死亡的独立危险因子:年龄增加、低白蛋白、低血钠、低血红蛋白(P0.05)。结论1.HFmr EF患者在心力衰竭患者中占有相当大一部分人群(23%);2.HFmr EF患者多为女性、糖尿病、贫血、冠心病患者,心房颤动的发生率低,入院收缩压较高,心率较慢,心功能较好。HFmr EF患者的实验室和超声心动图特征介于HFr EF患者和HFp EF患者之间,且更类似于HFp EF患者。3.在预后方面,HFmr EF与HFr EF、HFp EF三组患者的死亡率未见明显差异,但三组患者全因死亡的独立危险因子不同,HFmr EF组患者全因死亡的独立危险因子为冠心病、左室舒末内径和贫血。
[Abstract]:Objective To retrospectively analyze the heart failure ejection fraction of the intermediate range (heart failure with mid-range left ventricular ejection fraction, HFmr EF) and heart failure with preserved ejection fraction (heart failure with preserved left ventricular ejection fraction, HFp EF) and heart failure with reduced ejection fraction (heart failure with reduced the ejection fraction, HFr EF) patients the characteristics and influence of different prognosis factors, deepen our understanding of the HFmr EF, in order to provide reference for HFmr patients with EF prevention strategies. 620 patients with heart failure was collected from January 2014 to December 2015 in the Department of Cardiology of Henan Province People's Hospital hospitalized cases, finally met the inclusion and exclusion criteria of heart failure in patients with a total of 560 cases as the research object. According to the the value of LVEF, the research object will be divided into HFp EF (LVEF = 50%), HFmr EF (40% LVEF 49%) and HFr EF (LVEF40%), record the basic information, patients with clinical manifestations, echocardiography, electrocardiogram and clinical medication from January 2017 to February 2017 were followed up by telephone, the end point of the study was all-cause mortality. Analysis and comparison of HFp EF, HFmr EF and HFr EF three groups of patients with gender, age, cardiac structure and function, the difference of blood the biochemical indexes and prognosis factors. Using SPSS17.0 statistical software for data processing, the application of W test normality test, measurement data obey normal distribution or approximate normal distribution with x + s; accord with normal distribution, and variance, were compared between the three groups using single factor variance analysis, and then for group 22, two groups were compared using the LSD test; do not conform to normal distribution, and the heterogeneity of variance, using the Wilcoxon rank sum test (Kmskal-Wallis test); Zhi count data expressed as a percentage, comparison between groups using chi square test. Survival analysis of 2. 鐢↘aplan鈥擬eier鐢熷瓨鏇茬嚎,澶氬洜绱犲垎鏋愰噰鐢–OX姣斾緥椋庨櫓鍥炲綊妯″瀷.褰揚銆，

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