2021 年第 6 期 第 16 卷

缺血性心脏病和非缺血性心脏病所致射血分数中间值型心力衰竭患者预后的差异

The difference of prognosis in patients with heart failure with mid-range ejection fraction caused by ischemic heart disease and non-ischemic heart disease

作者：符浩1白融2

英文作者：Fu Hao1 Bai Rong2

单位：1首都医科大学附属北京安贞医院急诊危重症中心100029；2首都医科大学附属北京安贞医院心内科100029

英文单位：1Department of Hypertension Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Hypertension Research Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China

关键词：射血分数中间值型心力衰竭；缺血性心脏病；预后 

英文关键词：Essentialhypertension;Metabolicsyndrome;Ambulatorybloodpressuremonitoring;Circadianrhythm

• 摘要：

• 目的 探讨缺血性心脏病（IHD）与非缺血性心脏病（nIHD）所致射血分数中间值型心力衰竭(HFmrEF)患者预后的差异。方法 选取2018年6月至2019年12月于首都医科大学附属北京安贞医院心内科门诊就诊的210例慢性HFmrEF患者，按心脏病类型分为IHD组（119例）和nIHD组（91例）。采集所有患者基线资料及入组时相关检查指标，并随访1年。采用Kaplan-Meier生存曲线分析HFmrEF患者1年全因死亡率及因心力衰竭急性加重再住院率；采用Cox回归模型分析HFmrEF患者发生全因死亡的危险因素。结果 随访1年期间，210例患者中41例（19.5%）死亡，67例（31.9%）因心力衰竭急性加重再住院。Kaplan-Meier生存曲线分析结果显示，IHD组1年全因死亡率高于nIHD患者（Log-rank χ2=5.402，P=0.020），2组随访1年期间因心力衰竭急性加重再住院率差异无统计学意义（Log-rank χ2=0.075，P=0.784）。多因素Cox回归分析结果显示年龄（风险比=1.053，95%置信区间：1.006～1.103，P=0.028）、IHD（风险比=2.051，95%置信区间：1.026～4.101，P=0.042）均为HFmrEF患者全因死亡的独立危险因素。结论 IHD所致HFmrEF患者的1年全因死亡率高于nIHD患者，IHD是HFmrEF患者发生全因死亡的独立危险因素。

• Objective To investigate the characteristics of ambulatory blood pressure in patients with essential hypertension complicated with metabolic syndrome(MS). Methods From June 2012 to December 2015, clinical data of 1 457 patients with essential hypertension hospitalized in Department of Hypertension, Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed. They were divided into MS group(1 100 cases) and non-MS group(357 cases) according to whether they had MS or not. General data, laboratory indicators and the result of 24 h ambulatory blood pressure monitoring were compared between the two groups. The influencing factors for dipper blood pressure in patients with essential hypertension were analyzed. Results The rate of male, body mass index, waist, and rates of smoking history, diabetes mellitus and hyperlipidemia in MS group were higher than those in non-MS group ［60.1%（661/1 100） vs 41.2%（147/357）, (28±4)kg/m2 vs （25±4)kg/m2, （100±9）cm vs （90±11）cm, 40.6%（447/1 100） vs 22.7%（81/357）, 40.6%（447/1 100） vs 3.9%（14/357）, 85.3%（938/1 100） vs 59.4%（212/357）］(all P<0.01). The levels of serum creatinine, serum uric acid, triacylglycerol, C-reactive protein, fasting plasma glucose and 2 h postprandial glucose in MS group were higher than those in non-MS group, and high-density lipoproteins cholesterol level in MS group was lower than that in non-MS group(all P<0.05). The 24 h systolic blood pressure(SBP), daytime SBP, and nocturnal SBP and diastolic blood pressure(DBP) in MS group were higher than those in non-MS group, and the percentage of nocturnal SBP decreasing and percentage of nocturnal DBP decreasing in MS group were lower than those in non-MS group［(4.6±7.7)% vs (5.8±8.1)%, (7.1±7.8)% vs (8.1±8.4)%］(all P<0.05). The rate of dipper blood pressure in MS group was lower than that in non-MS group［8.9%(98/1 100) vs 68.1%(243/357)］(χ2=4.32， P=0.04). Logistic regression analysis showed that female (odds ratio=0.72, 95% confidence interval: 0.56-0.92， P＜0.01), elderly (odds ratio=0.97, 95% confidence interval: 0.97-0.98, P＜0.01) and complicated with MS (odds ratio=0.75, 95% confidence interval: 0.57-0.98， P=0.04) in patients with essential hypertension had lower probability of dipper blood pressure. Conclusions  Essential hypertensive patients complicated with MS have more cardiovascular risk factors and higher level of blood pressure. Patients with essential hypertension who were female, elderly and complicated with MS have lower probability of dipper blood pressure, and are likely to have abnormal circadian blood pressure rhythm.