| 吕逸宁,朱琳,刘君君,等.衰弱对老年轻中度慢性心力衰竭患者预后的影响[J].中国临床保健杂志,2021,24(4):473-477. |
| 衰弱对老年轻中度慢性心力衰竭患者预后的影响 |
| Impact of frailty on prognosis of elderly inpatients with cardiovascular disease |
| 投稿时间：2020-12-19 |
| DOI：10.3969/J.issn.1672-6790.2021.04.009 |
| 中文关键词: 衰弱 心力衰竭 预后 危险因素 老年人 |
| 英文关键词: Frailty Heart failure Prognosis Risk factors Aged |
| 基金项目: |
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| 中文摘要: |
| 目的 探讨衰弱对老年轻中度慢性心力衰竭(NYHA Ⅰ～Ⅲ级)患者短期预后的影响,并分析影响预后的危险因素。方法 本研究为前瞻性观察性研究,连续纳入2018年4月至2019年4月在清华大学第一附属医院住院诊治的老年轻中度慢性心力衰竭(NYHA Ⅰ～Ⅲ级)患者。依据是否合并衰弱,选择合并衰弱的71例患者为衰弱组；选择同期入院、年龄、体质指数和心功能(左室射血分数)类似的未合并衰弱的172例患者为对照组。随访12个月,记录主要不良心血管事件发生情况,包括全因死亡、因心力衰竭再次入院和恶性心律失常。应用Kaplan-Meier生存分析和Log-rank检验比较组间的不良心血管事件发生情况。应用单因素和多因素Cox比例风险回归模型检测不良心血管事件的危险因素。结果 243例老年轻中度慢性心力衰竭患者中,年龄(68.8±7.3)岁。衰弱组的超敏C反应蛋白(hs-CRP)明显升高(P＜0.05)。中位随访时间337 d,失访5例(2.1%)。随访期间,共发生98例(40.3%)不良心血管事件,包括全因死亡6例(2.5%)、因心力衰竭再入院75例(30.9%)和恶性心律失常19例(7.8%)。Kaplan-Meier生存分析和Log-rank检验结果提示,衰弱组患者的不良心血管事件发生率(60.6%比32.0%,P＜0.001)和因心力衰竭再入院(45.1%比25.0%,P=0.002)均显著高于对照组,但两组的全因死亡率(5.6%比1.2%,P=0.055)和恶性心律失常(12.7%比5.8%,P=0.082)发生率无明显差别。多因素Cox比例风险回归模型,以年龄、肌酐清除率、白蛋白、hs-CRP、N末端B型利钠肽前体(NT-proBNP)为协变量,结果显示衰弱是不良心血管事件的独立危险因素(HR=1.507,95%CI:1.113～2.041,P=0.008)。结论 衰弱可显著增加老年轻中度慢性心力衰竭(NYHA Ⅰ～Ⅲ级)患者的因心力衰竭再住院的发生率,且为不良心血管事件的独立危险因素。 |
| 英文摘要: |
| Objective To explore the effect of weakness on the short-term prognosis of elderly patients with heart failure,and analyze the risk factors affecting the prognosis.Methods This study is a prospective observational study,and continuously included elderly heart failure patients hospitalized in our hospital from April 2018 to April 2019.According to whether or not debilitating,71 patients with debilitating degeneration were selected as debilitating group;172 patients without desensitization with similar admission,age,body mass index and cardiac function (left ventricular ejection fraction) were selected as control group.Followed up for 12 months,the main adverse events were recorded,including all-cause death,re-admission to heart failure and malignant arrhythmia.Kaplan-Meier survival analysis and Log-rank test were used to compare the occurrence of adverse cardiovascular events between groups.Univariate and multivariate Cox proportional hazard regression models were used to detect risk factors for adverse cardiovascular events.Results Among the 243 patients,the average age was (68.8±7.3)years.High-sensitivity CRP was significantly increased (P<0.05).The median follow-up time was 337 days,and 5 cases (2.1%) were lost to follow-up.During the follow-up period,a total of 98(40.3%) adverse cardiovascular events occurred,including 6 all-cause deaths (2.5%),75 hospital readmissions due to heart failure (30.9%),and 19 malignant arrhythmias (7.8%)).Kaplan-Meier survival analysis and Log-rank test results showed that the incidence of adverse cardiovascular events in the debilitated group (60.6% vs.32.0%,P<0.001) and readmission due to heart failure (45.1% vs.25.0%,P=0.002) Both were significantly higher than the control group,but the incidence of all-cause mortality (5.6% vs.1.2%,P=0.055) and malignant arrhythmia (12.7% vs.5.8%,P=0.082) were not significantly different between the two groups.Multivariate Cox proportional hazards regression model,using age,creatinine clearance,albumin,hsCRP,NT-proBNP as covariates,the results show that degeneration is an independent risk factor for adverse cardiovascular events (HR=1.507,95%CI:1.113-2.041,P=0.008).Conclusion Frailty can significantly increase the incidence of heart failure rehospitalization in elderly patients with heart failure and is an independent risk factor for adverse cardiovascular events. |
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