临床参数在慢性心力衰竭全因死亡中的预测价值

【作者】 郝素芳；

【导师】 浦介麟；

【作者基本信息】 北京协和医学院 ， 内科学， 2012， 博士

【摘要】 研究目的研究年龄、体重指数(BMI)是否能预测慢性心衰患者全因死亡。方法入组1197例慢性心力衰竭(CHF)患者,包括缺血性心脏病(ICM)706例及扩张型心肌病(DCM)491例,获得住院时的基线病历资料后,进行电话及门诊为主的随访(至2010年12月),以死亡为随访终点。对不同年龄层次、不同BMI水平人群进行其他预后相关危险因素的比较,连续型资料行单因素方差分析,分组资料行X2检验。对完成随访的资料行生存分析,通过Kaplan-Meier法描述生存时间及生存率,组间生存率比较应用Log-rank检验。单因素Cox回归用于判断各影响因素与心衰死亡的关系,对有统计学意义的指标进一步行多元COX回归,以明确年龄、BMI是否为心衰死亡的独立预测因子。结果1025例完成随访,其中死亡360例,存活665例；中位随访期44个月。不同年龄层及不同BMI水平心衰患者在临床伴发疾病、血压、左室射血分数(LVEF)、多种检验项目及用药方面存在显著差异。随着年龄增长,死亡率增加；随着BMI增长,死亡率减少。校正其他影响因素后,年龄增长及BMI减低均为死亡独立预测因素。结论在对临床基线数据的单因素分析中,男性、较高的BMI,高的LVEF及收缩压、舒张压,合并高血压病、高脂血症均为心衰患者预后的保护因素,而年龄、合并室速为危险因素。多因素校正后,高的BMI及LVEF仍为强的心衰预后保护因子,年龄增长、合并室速则独立增加心衰患者死亡风险。其中,年龄、BMI为相对较新的独立预测因子,年龄增长增加心衰患者死亡风险,而BMI增加将降低心衰患者死亡率。研究目的研究血红蛋白浓度(Hb)、总胆红素水平(Tbil)是否能预测慢性心衰患者全因死亡。方法入组1197例慢性心力衰竭(CHF)患者,包括缺血性心脏病(ICM)706例及扩张型心肌病(DCM)491例,获得住院时的基线病历资料后,进行电话及门诊为主的随访(至2010年12月),以死亡为随访终点。对不同Hb浓度、不同Tbil水平人群进行其他预后相关危险因素的分析,连续型资料行单因素方差分析或独立t检验,分组资料行X2检验。对完成随访的资料行生存分析,通过Kaplan-Meier法描述生存时间及生存率,组间生存率比较应用Log-rank检验。单因素Cox回归用于判断各影响因素与心衰死亡的关系,对有统计学意义的指标进一步行多元COX回归,以明确Hb、Tbil是否为心衰死亡的独立预测因子。结果1025例完成随访,其中死亡360例,存活665例；中位随访期44个月。不同Hb及不同Tbil水平心衰患者在临床伴发疾病、血压、左室射血分数(LVEF).其他检验项目及用药方面存在显著差异。随着Hb减低,死亡率增加；随着Tbil增高,死亡率增加。校正其他影响因素后,Hb减低及Tbil升高均为心衰患者死亡的独立预测因素。结论在单因素分析中,血液化验指标包括总胆红素(Tbil)、血钾、肌酐、尿素氮、尿酸(UA)均为心衰死亡的危险因素；而血红蛋白(Hb)、白蛋白(ALB)、血钠(Na+)、甘油三酯(TG)、高密度脂蛋白(HDL)升高均为心衰预后的保护因素。多因素分析,仅Hb、Tbil和UA与心衰死亡独立相关,其中Hb和Tbil是两个较新的预测因素。研究目的研究长期应用口服袢利尿剂是否会增加慢性心衰患者全因死亡。方法入组1197例慢性心力衰竭(CHF)患者,包括缺血性心肌病(ICM)706例及扩张型心肌病(DCM)491例,获得住院时的基线病历资料后,进行电话及门诊为主的随访(至2010年12月),以死亡为随访终点。对应用不同剂量袢利尿剂人群进行其他预后相关危险因素的分析,连续型资料行单因素方差分析,分组资料行X2检验。对完成随访的资料行生存分析,通过Kaplan-Meier法描述生存时间及生存率,组间生存率比较应用Log-rank检验。单因素Cox回归用于判断各影响因素与心衰死亡的关系,对有统计学意义的指标进一步行多元COX回归,以明确长期应用袢利尿剂是否为心衰死亡的独立预测因子。结果1025例完成随访,其中死亡360例,存活665例；中位随访期44个月。应用不同袢利尿剂剂量的心衰患者在临床伴发疾病、血压、左室射血分数(LVEF)、其他检验项目及用药方面存在差异。随着袢利尿剂应用剂量增加,死亡率增加。校正其他影响因素后,应用袢利尿剂仍为心衰患者预后的危险因素。结论单因素分析,应用螺内酯、袢利尿剂均为心衰死亡的危险因素；而应用他汀、阿司匹林则为心衰死亡的保护因素。多因素校正后,仅应用袢利尿剂及ACEI为心衰患者预后的预测因子。应用ACEI/ARB可降低心衰死亡风险,而应用袢利尿剂且随着剂量增加,死亡风险增高。更多还原

【Abstract】 Aging and low body mass index (BM1) may predict higher mortality in patients with chronic heart failureObjectives To investigate the predictive value of age and body mass index(BMI) for all-cause death in patients with chronic heart failure (CHF) Methods1197consecutive patients with CHF admitted in Fu Wai Cardiovascular Hospital were recruited. Among which706cases were ischaemic cardiomyopathy (ICM) and491cases were dilated cardiomyopathy(DCM).The study population was followed up until Dec2010either by telephone contact or out-patient visit. The end point was all-cause death. Analysis of variance was used for continuous data when comparing the age/BMI levels and chi-square test was used to compare categorical data. We performed survival analysis on the successful follow-up CHF population.Kaplan-Meier plots were used to describe survival during the observation period in different patient groups. Log-rank test was used to identify differences between groups. Univariate Cox regression analyses were performed in estimating Hazard ratios (HRs) for time to cardiac death and statistically significant predictors of mortality at baseline were entered into the multivariate Cox regression model to reveal the predictive significance of age, as well as BMI.Results During a median follow-up period of44months,1025cases were successful to follow-up.360individuals died and665cases survived. Statistical Differences were found in co-morbidity, blood pressure, LVEF, laboratory results and medication between the age groups.Advancing age and lower BMI increased all-cause mortality in patients with CHF. After adjusted for other risk factors, age and BMI remained independent predictors of mortality in CHF patients.Conclusions In a univariate analysis, male, high BMI, LVEF,SBP and DBP, history of hypertension and hyperlipemia were protective factors,while advancing age and history of VT were risk factors in predicting higher mortality in patients with CHF. A multivariate analysis demonstrated that aging and lower BMI, lower LVEF, history of VT were independent factors associated with worse survival. Advancing age and Lower BMI were new baseline parameters independently predicting mortality in patients of CHF. Lower Hemoglobin concentration and higher total bilirubin may predict higher mortality in patients with chronic heart failureObjectives To investigate the predictive value of Hemoglobin (Hb) and total bilirubin(Tbil) for all-cause death in patients with chronic heart failure (CHF) Methods1197consecutive patients with CHF admitted in Fu Wai Cardiovascular Hospital were recruited. Among which706cases were ischaemic cardiomyopathy (ICM) and491cases were dilated cardiomyopathy(DCM).The study population was followed up until Dec2010either by telephone contact or out-patient visit. The end point was all-cause death. Analysis of variance and independent t-test were used for continuous data when comparing the hemoglobin/bilirubin levels and chi-square test was used to compare categorical data. We performed survival analysis on the successful follow-up CHF population. Kaplan-Meier plots were used to describe survival during the observation period in different patient groups. Log-rank test was used to identify differences of survival between groups. Univariate Cox regression analyses were performed in estimating Hazard ratios (HRs) for time to cardiac death and statistically significant predictors of mortality at baseline were entered into the multivariate Cox regression model to reveal the predictive significance of hemoglobin, as well as total bilirubin.Results During a median follow-up period of44months,1025cases were successful to follow-up.360individuals died and665cases survived. Statistical Differences were found in co-morbidity, blood pressure, LVEF, laboratory results and medication between the Hb/Tbil groups.Lower Hb and higher Tbil increased cardiac mortality in patients with CHF. After adjusted for other risk factors, Hb and Tbil remained independent predictors of mortality in CHF patients.Conclusions In a univariate analysis, parameters of laboratory examination including Tbil, potassium, serum creatinine(Scr],bbod urea nitrogen[BUN), uric acid(UA) were all risk factors,while Hb, albumin(ALB] and sodium, triglyceride, high-density lipoprotein were protective factors in predicting higher mortality in patients with CHF. A multivariate analysis demonstrated that lower hemoglobin and higher Tbil, higher UA were independent factors associated with worse survival. Higher Tbil and Lower Hb were new laboratory parameters independently predicting mortality in patients of CHF. Chronic use of loop diuretics may predict worse outcome in patients with chronic heart failureObjectives To investigate whether chronic use of oral loop diuretic could identify patients with chronic heart failure (CHF) of adverse prognosis.Methods1197consecutive patients with CHF admitted in Fu Wai Cardiovascular Hospital were recruited. Among which706cases were ischaemic cardiomyopathy (ICM) and491cases were dilated cardiomyopathy(DCM).The study population was followed up until Dec2010either by telephone contact or out-patient visit. The end point was all-cause death. Analysis of variance were used for continuous data when comparing the levels of loop-diuretic dosage and chi-square test was used to compare categorical data. We performed survival analysis on the successful follow-up CHF population. Kaplan-Meier plots were used to describe survival during the observation period in different patient groups. Log-rank test was used to identify differences of survival between groups. Univariate Cox regression analyses were performed in estimating Hazard ratios (HRs) for time to death and statistically significant predictors of mortality at baseline were entered into the multivariate Cox regression model to reveal the predictive significance of medication of loop diuretic.Results During a median follow-up period of44months,1025cases were successful to follow-up.360individuals died and665cases survived. Statistical Differences were found in co-morbidity, blood pressure, LVEF, laboratory results and medication between the different dosage groups.Use of Higher-dose loop-diuretic increased all-cause mortality in patients with CHF. After adjusted for other risk factors, chronic use of Loop-diuretic remained predictors of mortality in CHF patients.Conclusions. In a univariate analysis, medication of spironolactone, loop diuretic were risk factors,while use of aspirin and statins were protective factors in predicting higher mortality in patients with CHF. Adjusted for other factors, use of ACEI/ARB was a favorable factor independently associated with better survival. Chronic use of Loop diuretic was independent factors in predicting worse outcomes in patients with CHF.更多还原