摘要
目的探讨75岁及以上急性心衰患者的临床特点及死亡原因。方法试验设计属于前瞻性随访研究，以2012年1月至-2014年12月期间符合条件的急性心衰患者为研究对象。根据年龄分为年龄≥75岁组和年龄〈75岁组，记录患者的一般临床资料。随访以电话随访为主，辅以住院随访、门诊随访。生存率估算应用Kaplan—Meier法，组间生存率曲线差异采用Logrank检验，应用多变量Cox比例风险回归分析死亡的独立危险因素。结果与年龄〈75岁组相比，年龄≥75岁组缺血性心脏病、高血压病、陈旧性心肌梗死比例较高，男性、糖尿病比例和体质指数（BMI）较低。年龄较高组左心室射血分数（LVEF）水平较高，总胆固醇、三酰甘油、低密度脂蛋白胆固醇（LDL-C）水平较低。KaplanMeier曲线表明，年龄≥75岁组全因死亡率（χ^2=4．005，P=0．045）、非心血管死亡率（χ^2=4．418，P=0．041）显著高于年龄〈75岁组，而心血管病死亡率无显著差异（χ^2=0．754，P=0．385）。在非心血管死亡的患者中，年龄≥75岁组死于肺部感染者12例（63．2％），年龄〈75岁组死于肺部感染者3例（25．0％），2组之间有统计学意义（χ^2=4．288，P=0．038）。多变量Cox比例风险回归分析显示年龄≥75岁是预测急性心衰患者全死因[HR（95％CI）：1．75（1．28～3．13），Waldχ^2=2．914，P=0．026]和非心血管死亡[HR（95％CI）：2．71（1．50～6．55），Waldχ^2=2．266，P=0．0383的独立危险因素。结论年龄≥75岁是影响急性心衰患者全死因和非心血管病死亡的独立危险因素，但是并非影响心血管病死亡的独立危险因素，这对于建立更合理的老年心衰治疗策略具有一定的指导意义。
Objective To explore the clinical characteristics and causes of death in patients with acute heart failure at aged 75 and over. Methods The prospective study collected 175 patients with aeute heart failure from January 2012 to December 2014. They were divided into ≥75 years old group and〈75 years old group and the general clinical data were recorded. Follow-up was performed mainly by telephone with supplemented hospitalization follow-up and outpatient follow-up. Survival rates were assessed by Kaplan-Meier method. The survival rate difference between the two groups was compared using the log-rank test. Multivariate Cox proportional hazards regression analysis was used to determine the independent risk factors for death. Results The proportions of ischemic heart disease, hypertension and old myocardial infarction were higher in the elderly group than in the young group with a higher proportion of male, diabetes and body mass index in 〈75 years old group. Elderly group had a higher level of left ventricular ejection fraction（LVEF）and a lower level of total cholesterol, triglycerides and low density lipoprotein cholesterol（LDL-C）. Kaplan-Meier curves showed that all- cause mortality（χ^2 = 4. 005,P= 0. 045） and non cardiovascular mortality（χ^2= 4. 418,P= 0. 041） were significantly higher in the elderly group than in the younger group, whereas cardiovascular mortality had no significant difference between the two groups （χ^2 = 0. 754, P = 0. 385 ）. In patients with non cardiovascular mortality, 12 cases （63.2%）died of pulmonary infection in elderly group, 3 cases （25.0%） died of lung infection in younger group, and the difference was statistically significant between the 2 groups （χ^2 = 4. 288, P = 0. 038） . Multivariate Cox proportional hazards regression analysis showed that age≥75 years was an independent predictor for both non-cardiovascular mortality [HR（95%CI） ：2.71（1.50-6.55） ,Wald χ^2 =2. 266,P=0. 038land all-cause mortality[HR（95GCI）：1.75 （ 1.28-3.13）, Waldχ^2 = 2.914, P =0. 026 ] in patients with acute heart failure. Conclusions Age ≥75 years is an independent risk factor for all dead patients with acute heart failure and non- cardiovascular death,but it is not the independent risk factors for cardiovascular death, which is of great significance to establish a more rational treatment strategy for senile heart failure.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2017年第6期650-654,共5页
Chinese Journal of Geriatrics
基金
河南省科技发展计划（17210241001）
河南省医学科技攻关计划（201602262）
关键词
急性失代偿心力衰竭
危险因素
预后
Acute decompensated heart failure
Risk factors
Prognosis
