射血分数保留的心力衰竭合并心房颤动患者临床特征及再入院危险因素

doi:10.3969/j.issn.1004-583X.2023.04.003

摘要/Abstract

摘要：

目的探讨射血分数保留的心力衰竭(ejection fraction preserved heart failure,HFpEF)合并心房颤动(atrial fibrillation,AF)患者的临床特征及再入院危险因素。方法回顾性分析2018年6月至2020年5月于河北省人民医院住院治疗的459例HFpEF患者的临床资料,依据住院期间患者是否存在AF分为AF组(n=242)和窦性心律(sinus rhythm,SR)组(n=217)。比较两组临床资料,分析HFpEF合并AF患者的临床特征,并进一步探讨HFpEF合并AF患者再入院的危险因素。结果与 SR 组相比,AF 组年龄较大、吸烟史比例较小、体重指数较小、收缩压较低,合并高脂血症、缺血性心肌病比例较小,合并躯体化障碍、心脏瓣膜病比例较高,左心室收缩末内径、肺动脉收缩压、氨基末端脑钠肽前体、左房内径、右房内径、右室内径较高,左心室舒张末内径较小,使用脑啡肽酶抑制剂、钙离子拮抗剂、抗血小板药比例较低,使用抗凝药、洋地黄类药物比例较高,差异有统计学意义(P<0.05)。单因素及多因素Logistic回归分析显示,合并躯体化障碍、2型糖尿病、高尿酸血症是HFpEF合并AF患者再入院的独立危险因素,使用β受体阻滞剂是HFpEF合并AF患者再入院的独立保护因素。结论合并AF和不合并AF的HFpEF住院患者临床资料存在差异。2型糖尿病、高尿酸血症、合并躯体化障碍可能是HFpEF合并AF再入院的危险因素,而β受体阻滞剂可能是HFpEF合并AF的独立保护因素。

关键词: 射血分数保留型心力衰竭, 心房颤动, 临床特征, 合并症

Abstract:

Objective To investigate the clinical characteristics and readmission risk factors of patients with ejection fraction preserved heart failure (HFpEF) and atrial fibrillation (AF). Methods The clinical data of 459 patients with HFpEF hospitalized at the Hebei General Hospital from June 2018 to May 2020 were retrospectively analyzed, and they were allocated to AF group (n=242) and sinus rhythm (SR) group (n=217) based on the presence or absence of AF during hospitalization. The clinical data of the two groups were compared, the clinical characteristics of patients with HFpEF and AF were analyzed; further, the readmission risk factors were discussed. Results Compared with those of the SR group, patients in the AF group presented significantly older age, lower proportion of smokers, body mass index (BMI), systolic blood pressure (SBP), proportion of comorbidities of hyperlipidemia and ischemic cardiomyopathy, and proportion of using neprilysin inhibitors, calcium antagonists and antiplatelet drugs, andhigher proportion of comorbidities of somatization disorder and heart valve disease, left ventricular end-systolic diameter, pulmonary artery systolic pressure, B-type natriuretic peptide, left and right atrium diameter, right ventricular diameter, and proportion of using anticoagulant and digitalis(all P<0.05). Univariate and multivariate logistic regression analysis showed that somatization disorder, type 2 diabetes, hyperuricemia, β-blockers were independent risk factors for readmission in patients with HFpEF and AF. Conclusion There were significant differences in clinical profiles between HFpEF patients with and without AF. The comorbidities such as type 2 diabetes, hyperuricemia, and the somatization disorder may be risk factors for readmission in patients with HFpEF and AF, whereas β-blockers may be an independent protective factor for it.

Key words: heart failure with preserved ejection fraction, atrial fibrillation, clinical features, comorbidities

中图分类号:

R541.6

王震, 杨晓月, 李少杰, 王贤, 陈淑霞, 谷剑. 射血分数保留的心力衰竭合并心房颤动患者临床特征及再入院危险因素[J]. 临床荟萃, 2023, 38(4): 308-314.

Wang Zhen, Yang Xiaoyue, Li Shaojie, Wang Xian, Chen Shuxia, Gu Jian. Analysis of clinical characteristics and readmission risk factors in patients with ejection fraction preserved heart failure combined with atrial fibrillation[J]. Clinical Focus, 2023, 38(4): 308-314.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.04.003

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I4/308

图/表 9

参考文献 30

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组别	例数	年龄 (岁)	性别[例(%)]		吸烟史 [例(%)]	BMI (kg/m²)	血压(mmHg)		入院心率 (次/min)	NYHA分级[例(%)]
组别	例数	年龄 (岁)	男性	女性	吸烟史 [例(%)]	BMI (kg/m²)	收缩压	舒张压	入院心率 (次/min)	2级	3级	4级
AF组	242	77.0(59.8, 84.0)	109(45.0)	133(55.0)	34(14.0)	23.50(20.28, 26.23)	134(118, 151)	76(66, 86)	80(68, 96)	55(22.7)	116(48.0)	71(29.3)
SR组	217	70.0(62.0, 80.0)	114(52.5)	103(47.5)	52(24.0)	24.20(21.88, 27.68)	142(126, 159)	78(68, 91)	78(68, 90)	52(24.0)	102(47.0)	63(29.0)
统计值		Z=5.242	χ²=2.572		χ²=7.385	Z=-2.912	Z=-3.273	Z=-1.533	Z=1.578	χ²=0.099
P值		0.001	0.109		0.007	0.004	0.001	0.125	0.114	0.169

组别	例数	年龄 (岁)	性别[例(%)]		吸烟史 [例(%)]	BMI (kg/m²)	血压(mmHg)		入院心率 (次/min)	NYHA分级[例(%)]
组别	例数	年龄 (岁)	男性	女性	吸烟史 [例(%)]	BMI (kg/m²)	收缩压	舒张压	入院心率 (次/min)	2级	3级	4级
AF组	242	77.0(59.8, 84.0)	109(45.0)	133(55.0)	34(14.0)	23.50(20.28, 26.23)	134(118, 151)	76(66, 86)	80(68, 96)	55(22.7)	116(48.0)	71(29.3)
SR组	217	70.0(62.0, 80.0)	114(52.5)	103(47.5)	52(24.0)	24.20(21.88, 27.68)	142(126, 159)	78(68, 91)	78(68, 90)	52(24.0)	102(47.0)	63(29.0)
统计值		Z=5.242	χ²=2.572		χ²=7.385	Z=-2.912	Z=-3.273	Z=-1.533	Z=1.578	χ²=0.099
P值		0.001	0.109		0.007	0.004	0.001	0.125	0.114	0.169

组别	例数	高脂血症		高血压		冠状动脉疾病		心脏瓣膜病		缺血性心肌病		脑血管病		慢性阻塞性肺疾病
AF组	242	28(11.6)		165(68.2)		143(59.1)		134(55.4)		16(6.6)		98(40.5)		19(7.9)
SR组	217	41(18.9)		159(73.3)		141(65.0)		60(27.6)		35(16.1)		78(35.9)		15(6.9)
χ²值		4.804		1.428		1.680		36.032		10.493		1.002		0.147
P值		0.028		0.232		0.195		0.001		0.001		0.317		0.701
组别	2型糖尿病		慢性肾病		高尿酸血症		结缔组织病		躯体化障碍		甲状腺功能亢进症		甲状腺功能减退症		颈动脉粥样硬化
AF组	72(29.8)		50(20.7)		58(24.0)		7(2.9)		31(12.8)		8(3.3)		31(12.8)		88(36.4)
SR组	80(36.9)		52(24.0)		39(18.0)		12(5.5)		13(6.0)		2(0.9)		24(11.1)		67(30.9)
χ²值	2.614		0.722		2.467		2.006		6.138		3.051		0.332		1.541
P值	0.106		0.396		0.116		0.157		0.013		0.081		0.564		0.215

组别	例数	高脂血症		高血压		冠状动脉疾病		心脏瓣膜病		缺血性心肌病		脑血管病		慢性阻塞性肺疾病
AF组	242	28(11.6)		165(68.2)		143(59.1)		134(55.4)		16(6.6)		98(40.5)		19(7.9)
SR组	217	41(18.9)		159(73.3)		141(65.0)		60(27.6)		35(16.1)		78(35.9)		15(6.9)
χ²值		4.804		1.428		1.680		36.032		10.493		1.002		0.147
P值		0.028		0.232		0.195		0.001		0.001		0.317		0.701
组别	2型糖尿病		慢性肾病		高尿酸血症		结缔组织病		躯体化障碍		甲状腺功能亢进症		甲状腺功能减退症		颈动脉粥样硬化
AF组	72(29.8)		50(20.7)		58(24.0)		7(2.9)		31(12.8)		8(3.3)		31(12.8)		88(36.4)
SR组	80(36.9)		52(24.0)		39(18.0)		12(5.5)		13(6.0)		2(0.9)		24(11.1)		67(30.9)
χ²值	2.614		0.722		2.467		2.006		6.138		3.051		0.332		1.541
P值	0.106		0.396		0.116		0.157		0.013		0.081		0.564		0.215

组别	例数	LVEF (%)	LVEDD (mm)	LVESD (mm)	LA (mm)	RA (mm)	RV (mm)	PASP (mmHg)	血红蛋白 (g/L)	NT-proBNP (pg/ml)	GFR (ml/min)
AF组	242	59.0(56.0,64.0)	47(44,51)	32(29,36)	46(42,50)	38(33,43)	34(31,39)	48.5(38.0, 60.0)	123(108,134)	2 335.5(1 138.0,4 504.0)	67.91(49.88,4.17)
SR组	217	60.0(56.0,66.0)	48(44,51)	31(29,35)	41(37,45)	33(30,36)	32(29,34)	39.0(31.0, 53.0)	124(102,138)	1 837.0(551.0,4 325.0)	71.44(45.64,88.78)
Z值		0.059	5.112	8.494	8.343	7.812	5.841	4.691	0.056	2.754	0.787
P值		0.808	0.024	0.004	0.001	0.001	0.001	0.001	0.956	0.004	0.291