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摘要: 目的 探讨老年顽固性心力衰竭(refractory heart failure，RHF)患者合并低血压(low blood pressure，LBP)的相关危险因素，为临床防治提供思路。方法 收集重庆医科大学附属第二医院老年科在2018年1月—2020年12月住院的老年(≥65岁)顽固性心力衰竭(心衰)患者569例，按入院时血压分为顽固性心衰合并低血压组(RHF+LBP组)和单纯顽固性心衰组(单纯RHF组)，比较两组患者的基线资料、合并疾病情况、用药情况，应用多因素logistic逐步回归分析老年RHF合并LBP的危险因素。结果 在569例老年RHF患者中，103例(18.1%)合并LBP，单纯RHF患者466例(81.9%)。与单纯RHF组相比，RHF+LBP组患者心率、N末端B型利钠肽前体(NT-proBNP)、血尿素氮、高敏肌钙蛋白T均升高，右房横径更大，而高密度脂蛋白胆固醇(HDL-C)、血清白蛋白、左室射血分数均降低，合并扩张型心肌病、使用利尿剂的患者比例增加(P＜0.05)。多因素logistic回归分析显示ln(NT-proBNP)升高、心率增快、HDL-C降低是RHF合并LBP的独立影响因素。结论 LBP在老年RHF患者中较常见，与NT-proBNP、心率、HDL-C有关。Abstract: Objective To explore the clinical characteristics of elderly patients with refractory heart failure(RHF) complicated with low blood pressure(LBP), and to provide ideas for clinical prevention and treatment.Methods A total of 569 elderly patients(≥65 years old) with RHF hospitalized in the Department of Geriatrics of the second affiliated Hospital of Chongqing Medical University from January 2018 to December 2020 were collected and divided into RHF with LBP group(RHF+LBP group) and simple RHF group according to their blood pressure at the time of admission. The baseline data, combined diseases and medication of the two groups were compared. Multivariate Logistic stepwise regression was used to analyze the risk factors of elderly RHF patients complicated with LBP.Results Of the 569 elderly patients with RHF, 103(18.1%) were complicated with LBP and 466(81.9%) with simple RHF. Compared with the simple RHF group, the heart rate, N-terminal B-type natriuretic peptide precursor(NT-proBNP), blood urea nitrogen and high sensitivity troponin T were increased(P < 0.05), and the transverse diameter of right atrium was larger(P < 0.05), while high density lipoprotein cholesterol(HDL-C), serum albumin and left ventricular ejection fraction were decreased(P < 0.01), the proportion of patients complicated with dilated heart disease and using diuretics increased(P < 0.05) in RHF+LBP group. Multivariate Logistic regression analysis showed that increased NT-proBNP, increased heart rate and decreased HDL-C were independent risk factors for RHF complicated with LBP.Conclusion LBP is common in elderly patients with RHF. The increase of ln(NT-proBNP), the increase of heart rate and the decrease of HDL-C are independently related to LBP.
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Key words:
- refractory heart failure /
- low blood pressure /
- elderly /
- risk factors
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表 1 两组患者基线资料比较
Table 1. Baseline data between two groups
例(%), X±S, M(P25, P75) 项目 RHF+LBP组(103例) 单纯RHF组(466例) P 年龄/岁 80.97±7.20 81.31±7.53 0.680 男性 44(42.7) 181(38.8) 0.466 体重/kg 56.09(48.50，63.75) 58.02(50.00，65.00) 0.128 吸烟 30(29.1) 132(28.3) 0.871 饮酒 13(12.6) 68(14.6) 0.604 心率/(次/min) 86.98 ± 19.60 80.85 ± 16.45 0.001 Hb/(g/L) 120.78 ± 20.56 118.11 ± 21.46 0.251 NT-proBNP/(pg/mL) 7 877.97(1 863.0，9 350.0) 3 646.06(770.35，3 981.75) ＜0.001 Cr/(μmol/L) 116.05(70.30，113.30) 104.02(63.90，118.03) 0.054 BUN/(mmol/L) 10.97(6.80，14.28) 8.99(5.68，10.74) 0.001 GFR/(mL/min/1.73m2) 56.42(36.42，79.50) 60.99(41.08，81.53) 0.091 hs-cTnT/(ng/L) 40.9(15.0，51.0) 27.2(11.0，32.0) ＜0.001 CK/(U/L) 82.57(47.75，97.50) 100.45(4.0，108.53) 0.276 CK-MB/(U/L) 12.59(8.20，14.20) 12.84(8.23，14.08) 0.990 TG/(mmol/L) 1.05(0.73，1.21) 1.27(0.74，1.44) 0.086 TC/(mmol/L) 3.74 ± 1.09 3.91 ± 1.02 0.146 HDL-C/(mmol/L) 1.10(0.89，1.24) 1.20(0.95，1.41) 0.008 LDL-C/(mmol/L) 1.85(1.36，2.20) 1.86(1.33，2.27) 0.814 Alb/(g/L) 34.31 ± 5.04 36.02 ± 4.96 0.002 HbA1c/% 6.35(5.80，6.73) 6.62(5.70，6.80) 0.704 Glu/(mmol/L) 7.28(5.22，8.14) 6.95(5.09，7.49) 0.670 LAD/mm 41.69(36.00，47.00) 41.18(36.00，45.00) 0.140 RAD/mm 41.76(35.00，47.00) 39.24(34.00，43.00) 0.006 LVEDD/mm 49.42(42.00，54.00) 47.50(43.00，51.00) 0.449 LVEF/mm 59.91(50.00，72.00) 65.11(60.00，74.00) 0.011 
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表 2 两组患者合并临床疾病
Table 2. Combined clinical diseases between two groups
例(%) 合并症 RHF+LBP组(103例) 单纯RHF组(466例) P 高血压 54(52.4) 353(75.8) ＜0.001 糖尿病 32(31.1) 192(41.2) 0.057 血脂异常 21(20.4) 134(28.8) 0.084 脑卒中 19(18.4) 95(20.4) 0.656 心房颤动 49(47.6) 184(39.5) 0.131 冠心病 70(68.8) 364(78.1) 0.028 慢阻肺/肺心病 36(35.0) 137(29.4) 0.268 风湿性心脏病 3(2.9) 18(3.9) 0.862 扩张型心肌病 7(6.8) 8(1.7) 0.004 肥厚型心肌病 2(1.9) 3(0.488) 0.488
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表 3 两组患者住院期间用药情况
Table 3. Drug use between two groups during hospitalization
例(%) 住院期间用药 RHF+LBP组(103例) 单纯RHF组(466例) P 利尿剂 89(86.4) 351(75.3) 0.015 ACEI/ARB/ARNI 43(41.7) 231(46.9) 0.150 β-受体阻滞剂 70(68.8) 269(57.7) 0.055 抗血小板聚集药 52(50.5) 292(62.7) 0.022 调脂药 69(67.0) 387(83.0) ＜0.001 抗凝药 37(35.9) 139(29.8) 0.226
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表 4 RHF+LBP的多因素logisitc逐步回归分析
Table 4. Multivariate logisitc stepwise regression analysis of RHF combined with LBP
因素 B OR 95%CI P ln(NT- proBNP) 0.580 1.786 1.467~2.176 ＜0.001 心率 0.016 1.016 1.004~1.029 0.011 HDL-C -0.830 0.436 0.210~0.907 0.026
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| 引用本文: |
湛玥, 李兴升, 易衡静. 老年顽固性心力衰竭患者合并低血压的危险因素研究[J]. 临床心血管病杂志, 2023, 39(10): 782-787. doi: 10.13201/j.issn.1001-1439.2023.10.009
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| Citation: |
ZHAN Yue, LI Xingsheng, YI Hengjing. Risk factors of hypotension in elderly patients with refractory heart failure[J]. J Clin Cardiol, 2023, 39(10): 782-787. doi: 10.13201/j.issn.1001-1439.2023.10.009
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