2023 年第 4 期 第 18 卷

老年慢性心力衰竭患者住院期间营养不良风险及其与随访主要不良心脑血管事件的相关性

Hospitalization malnutrition risk in elderly patients with chronic heart failure and its correlation with the risk of major adverse cardiovascular and cerebrovascular events during follow-up

作者：祖晓麟王成钢李响曾亚平高海

英文作者：Zu Xiaolin Wang Chenggang Li Xiang Zeng Yaping Gao Hai

单位：首都医科大学附属北京安贞医院心内急诊冠脉病房,北京100029

英文单位：Intracardiac Emergency Coronary Disease Ward Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：慢性心力衰竭；营养风险筛查；预后；相关因素

英文关键词：Chronicheartfailure;Nutritionriskscreening;Prognosis;Relatedfactor

• 摘要：

• 目的 探讨老年慢性心力衰竭（CHF）患者住院期间的营养不良风险及其与随访主要不良心脑血管事件（MACCE）的相关性。方法 本研究为前瞻性队列研究。连续选取首都医科大学附属北京安贞医院2017年1月至2019年12月收治的老年CHF患者683例。入院24 h内应用2002年营养风险筛查量表（NRS-2002）评分进行营养不良风险筛查，根据结果分为高风险组（NRS-2002评分≥3分）和低风险组（NRS-2002评分<3分）。比较2组患者基线资料。随访2年，主要观察终点MACCE，为心血管死亡、因心力衰竭加重再入院、新发急性冠状动脉综合征和脑卒中的复合事件。采用Kaplan-Meier生存分析和Log-rank检验分析MACCE发生风险，单因素和多因素Cox回归分析临床指标与MACCE的相关性。结果 683例老年CHF患者中，605例（88.6%）患者为低营养不良风险（低风险组）、78例（11.4%）患者为高营养不良风险（高风险组）。2组年龄、体重指数、心力衰竭病程、缺血性心力衰竭比例、糖尿病比例、慢性肾病比例、血红蛋白、C反应蛋白、白蛋白、N末端B型脑钠肽前体（NT-proBNP）、估算肾小球滤过率（eGFR）、左心室射血分数、左心室舒张末期内径水平、住院时间以及噻嗪类利尿剂和硝酸甘油使用比例比较，差异均有统计学意义（均P＜0.05）。平均随访22.1个月，失访53例。随访期间，高风险组因心力衰竭加重再入院发生率和MACCE总发生率均高于低风险组（Log-rank χ2=4.526、6.818，P=0.031、0.001）。多因素Cox回归分析结果显示，NRS-2002评分与MACCE发生风险呈正相关（风险比=1.715,95%置信区间：1.121~2.624），此外，年龄（风险比=1.506,95%置信区间：1.118～2.029）、体重指数（风险比=1.347,95%置信区间：1.102～1.647）、心力衰竭病程（风险比=1.559,95%置信区间：1.198～2.029）、糖尿病（风险比=1.481,95%置信区间：1.034～2.121）、白蛋白（风险比=1.392,95%置信区间：1.075～1.803）、NT-proBNP（风险比=2.017,95%置信区间：1.136～3.581）和eGFR（风险比=1.473,95%置信区间：1.092～1.987）也与MACCE的发生风险独立相关（均P＜0.05）。结论 对老年CHF患者入院时进行营养风险筛查，有利于检出高营养不良风险患者，从而早期给予个性化的营养支持，改善患者预后。

• Objective To explore the hospitalization malnutrition risk in elderly patients with chronic heart failure (CHF) and its correlation with major adverse cardiovascular and cerebrovascular events (MACCE) during follow-up. Methods It was a prospective cohort study. Totally 683 elderly patients with CHF admitted to Beijing Anzhen Hospital, Capital Medical University from January 2017 to December 2019 were selected consecutively. Within 24 h after admission, nutritional risk screening (NRS-2002) score was used to investigate the nutritional status of patients, and they were divided into high-risk group (NRS-2002 score≥3) and low-risk group (NRS-2002 score<3) according to the results of NRS-2002. Baseline data of patients were compared between the two groups. Followed-up for 2 years, the main end point was MACCE, a complex event of cardiovascular death, re-admission due to aggravated heart failure, new acute coronary syndrome (ACS) and stroke. Kaplan-Meier survival analysis and Log-rank test were used to analyze the risk of MACCE. Univariate and multivariate Cox regression analyses were used to evaluate the correlation between clinical indexes and MACCE. Results Among the 683 elderly patients with CHF, 605 cases (88.6%) had low malnutrition risk (low-risk group) and 78 cases (11.4%) had high malnutrition risk (high-risk group). The age, body mass index, duration of heart failure, ischemic heart failure rate, diabetes mellitus rate, chronic kidney disease rate, hemoglobin, C-reactive protein, albumin, N-terminal pro-brain natriuretic peptide (NT-proBNP), estimated glomerular filtration rate (eGFR), left ventricular ejection fraction, left ventricular end diastolic diameter levels, length of stay, and application rates of thiazide diuretics and nitroglycerin were significantly different between the two groups (all P<0.05). The average follow-up was 22.1 months, and 53 cases were lost. During the follow-up period, the rate of re-admission due to aggravated heart failure and totally rate of MACCE in the high-risk group were higher than those in the low-risk group(Log-rank χ2=4.526, 6.818, P=0.031, 0.001). Multivariate Cox regression analysis showed that NRS-2002 score ［hazard ratio (HR)=1.715, 95% confidence interval(CI): 1.121-2.624］ was positively correlated with the risk of MACCE, and age (HR=1.506, 95%CI: 1.118-2.029), body mass index (HR=1.347, 95%CI: 1.102-1.647), duration of heart failure (HR=1.559, 95%CI: 1.198-2.029), diabetes mellitus (HR=1.481, 95%CI: 1.034-2.121), albumin (HR=1.392, 95%CI: 1.075-1.803), NT-proBNP (HR=2.017, 95%CI: 1.136-3.581) and eGFR (HR=1.473, 95%CI: 1.092-1.987) were also independently related to MACCE (all P<0.05). Conclusions  The nutritional risk screening of CHF patients at admission is conducive to the detection of patients with malnutrition, leading to early oersonalized nutritional support and it can improve patients outcomes.