老年射血分数保留型心衰合并衰弱的临床特征及NT-proBNP超声心动图参数变化的临床意义

doi:10.3969/j.issn.1006-6233.2023.09.013

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摘要 目的: 分析老年射血分数保留型心衰(HFpEF)合并衰弱的临床特征,外周血N末端B型利钠肽原(NT-proBNP)、超声心动图参数变化及临床意义。方法: 选取2021年2月至2023年2月本院收治的96例HFpEF患者;入院后24h内采用Fried衰弱评估标准评估衰弱情况,根据评估结果将患者分为衰弱组(n=56)和非衰弱组(n=40);收集两组临床资料,采用单因素分析及多因素Logsitic回归分析老年HFpEF合并衰弱的危险因素。结果: 衰弱组患者的年龄、NYHA分级Ⅲ/Ⅳ级比例、营养风险比例、NT-proBNP水平高于非衰弱组(P<0.05),血红蛋白(Hb)、白蛋白(ALB)水平低于非衰弱组(P<0.05)。衰弱组患者的左室射血分数(LVEF)低于非衰弱组(P<0.05),左室舒张末期内径(LVDD)、左室收缩末期内径(LVDS)和主动脉内径(AOD)高于非衰弱组(P<0.05);两组左房内径(LVDS)和左室后壁厚度(LVPW)比较差异无统计学意义(P>0.05)。多因素Logistic回归分析提示:高龄、NYHA分级Ⅲ/Ⅳ级、高NT-proBNP水平以及AOD增宽是老年HFpEF合并衰弱的的独立危险因素(P<0.05)。结论: 老年HFpEF患者衰弱患病率高,高龄、NYHA分级Ⅲ/Ⅳ级、高NT-proBNP水平以及AOD增宽是老年HFpEF合并衰弱的独立危险因素。

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关键词 ：老年, 心力衰竭, 射血分数保留型, 衰弱, 临床特征, 超声

Abstract：Objective: To analyze characteristics in elderly patients with heart failure with preserved ejection fraction (HFpEF) and frailty, and to explore the clinical significance of peripheral blood N-terminal pro-B-type natriuretic peptide (NT-proBNP) and echocardiogram parameters. Methods: A total of 96 patients with HFpEF admitted to the hospital were enrolled between February 2021 and February 2023. The frailty was evaluated by Fried Frailty Evaluation Criteria within 24h after admission. According to the evaluation results, patients were divided into frailty group (n=56) and non-frailty group (n=40). The clinical data in the two groups were collected. The risk factors of frailty were analyzed by univariate analysis and multivariate Logsitic regression analysis. Results: Compared with non-frailty group, the age, proportion of NYHA grading at grade III/IV, proportion of nutritional risk and NT-proBNP level in frailty group were higher (P<0.05), while levels of hemoglobin (Hb) and albumin (ALB) were lower (P<0.05). The left ventricular ejection fraction (LVEF) in frailty group was lower (P<0.05), while left ventricular end-diastolic diameter (LVDD), left ventricular end-systolic diameter (LVDS) aortic diameter (AOD) were longer or larger (P<0.05). There was no significant difference in left atrial diameter (LVDS) or left ventricular posterior wall thickness (LVPW) between the two groups (P>0.05). Multivariate Logistic regression showed advanced age, NYHA grading at grade III/IV, high-level NT-proBNP and widened AOD were independent risk factors of frailty in elderly patients with HFpEF (P<0.05). Conclusion: Elderly patients with HFpEF have high incidence of frailty. Advanced age, NYHA grading at grade III/IV, high-level NT-proBNP, and widened AOD are independent risk factors of frailty.

Key words： Elderly Heart failure Ejection fraction preservation Frailty Clinical characteristic Ultrasound

基金资助:海南省自然科学基金资助项目,(编号:819QN221)

通讯作者: 甘艳

引用本文:

吕秋, 邱清勇, 杜兰雪, 曹佳, 陈关欢, 甘艳, 李才彬. 老年射血分数保留型心衰合并衰弱的临床特征及NT-proBNP超声心动图参数变化的临床意义[J]. 河北医学, 2023, 29(9): 1479-1483.
LV Qiu, QIU Qingyong, DU Lanxue, et al. Clinical Characteristics and Clinical Significance of Changes in NT-proBNP and Echocardiographic Parameters in Elderly with Ejection Fraction Preserved Heart Failure Combined with Debility. HeBei Med, 2023, 29(9): 1479-1483.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2023.09.013 或 http://www.hbyxzzs.cn/CN/Y2023/V29/I9/1479

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