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中国人民解放军总医院
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解放军总医院医学创新研究部、国家老年疾病临床医学研究中心(解放军总医院)、解放军总医院第六医学中心心血管病医学部
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
主 编 范利
执行主编 陈韵岱
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
朱剑,边素艳,刘姗姗,王彬华,徐洪丽,何昆仑.老年射血分数保留的心力衰竭合并贫血患者心脏结构及功能分析[J].中华老年多器官疾病杂志,2023,22(1):19~23
老年射血分数保留的心力衰竭合并贫血患者心脏结构及功能分析
Cardiac structure and function in elderly heart failure patients with preserved ejection fraction complicated with anemia
投稿时间:2022-06-28  
DOI:10.11915/j.issn.1671-5403.2023.01.004
中文关键词:  老年人  射血分数保留的心力衰竭  贫血  心脏结构重构  左心室舒张功能
英文关键词:aged  heart failure with preserved ejection fraction  anemia  cardiac structural remodeling  left ventricular diastolic functionThis work was supported by the 2020 Public Service Platform Project of National Ministry of Industry and Information Technology
基金项目:工业和信息化部2020年产业技术基础公共服务平台项目(2020-0103-3-1)
作者单位
朱剑 中国人民解放军总医院第二医学中心心血管内科,北京 100853
中国人民解放军总医院国家老年疾病临床医学研究中心,北京 100853
慢性心衰精准医学北京市重点实验室,北京 100853中国人民解放军总医院医学创新研究部:北京 100853 
边素艳 中国人民解放军总医院第二医学中心心血管内科,北京 100853
中国人民解放军总医院国家老年疾病临床医学研究中心,北京 100853
慢性心衰精准医学北京市重点实验室,北京 100853中国人民解放军总医院医学创新研究部:北京 100853 
刘姗姗 中国人民解放军总医院第二医学中心心血管内科,北京 100853
中国人民解放军总医院国家老年疾病临床医学研究中心,北京 100853
慢性心衰精准医学北京市重点实验室,北京 100853中国人民解放军总医院医学创新研究部:北京 100853 
王彬华 灾害医学研究中心,北京 100853 
徐洪丽 大数据研究中心,北京 100853 
何昆仑 大数据研究中心,北京 100853 
摘要点击次数: 208
全文下载次数: 116
中文摘要:
      目的 分析老年射血分数保留的心力衰竭(HFpEF)合并贫血患者的心脏结构及功能特点。方法 选取2008年2月至2019年12月于中国人民解放军总医院第一医学中心住院的≥60岁的老年HFpEF患者2281例,根据是否合并贫血,分为贫血组(n=949)和对照组(n=1332)。分析2组患者的临床特征、心脏超声结构及功能差异。采用EmpowerStats统计软件(3.0版)和R软件进行数据分析。根据数据类型,组间比较分别采用独立样本t检验、Kruskal-Wallis H检验或χ2检验。采用多元线性回归模型分析血红蛋白(HGB)的影响因素,以及HGB与心脏超声指标的相关性。结果 老年HFpEF住院患者中41.6%(949/2281)合并贫血。贫血组男性[54.69%(519/949)和47.75%(636/1332)]、年龄[(74.79±7.99)和(73.40±7.72)年]、收缩压[(140.06±23.80)和(136.77±23.05)mmHg(1mmHg=0.133kPa)]、院内全因死亡率[3.58%(34/949)和1.50%(20/1332)]、空腹血糖[(7.68±3.35)和(7.02±3.38)mmol/L]、N末端B型利钠肽原(NT-proBNP)[3118.01(1137.21,8976.32)和1333.34(596.32,2777.11)ng/L]及肌钙蛋白T[0.04(0.02,0.08)和0.02(0.01,0.04)μg/L]显著高于对照组,体质量指数[(24.34±4.10)和(24.87±4.05)kg/m2]、HGB[(9.37±1.65)和(13.32±1.45)g/dl]及估算肾小球滤过率[38.85(13.98,73.98)和76.26(57.79,95.87)ml/(min·1.73m2)]显著低于对照组,差异均有统计学意义(均P<0.05)。2组间纽约心脏病协会心功能分级和慢性肾脏病(CKD)分期比较,差异均有统计学意义(均P<0.05)。心脏超声结果显示,与对照组相比,贫血组左心扩大更明显,表现为左心房前后径[(41.43±8.13)和(40.64±7.62)mm]、左心房容积指数[29.82(22.55,38.80)和28.38(20.55,38.96)ml/m2]、左心室收缩末期内径[(32.63±4.48)和(31.64±4.89)mm]、左心室舒张末期内径[(46.87±5.78)和(45.75±6.47)mm]、左心室收缩末期容量[(44.98±23.97)和(41.15±15.75)ml]及左心室舒张末期容量[(103.69±30.07)和(97.36±31.03)ml]显著增大;左心室肥厚更显著,表现为左心室质量指数[(120.24±39.99)和(110.14±36.91)g/m2]、左心室后壁厚度[(10.68±1.47)和(10.47±1.52)mm]显著增大;右心负荷加重,表现为右心室内径[(36.74±7.12)和(35.90±7.42)mm]、主肺动脉内径[(22.93±3.40)和(22.51±3.63)mm]及下腔静脉内径[(16.89±4.18)和(16.15±3.93)mm]显著增宽,差异均有统计学意义(均P<0.05)。多元线性回归分析显示,C-反应蛋白、NT-proBNP及CKD≥4期是HGB的独立危险因素。HGB是左心室收缩末期容量、左心室舒张末期容量、左心室收缩末期内径、左心室舒张末期内径、左心室质量指数及左心房容积指数的独立危险因素。结论 老年HFpEF住院患者贫血患病率高,合并贫血者心脏结构重构和舒张功能障碍更为显著。炎症、心肾功能差是贫血的独立危险因素,而贫血与心脏结构和功能改变密切相关。
英文摘要:
      Objective To analyze the characteristics of cardiac structure and function in elderly heart failure patients with preserved ejection fraction (HFpEF) complicated with anemia. Methods A total of 2281 elderly HFpEF patients ≥60 years old hospitalized in the First Medical Center of Chinese PLA General Hospital from February 2008 to December 2019 were enrolled and divided into anemia group (n=949) and control group (n=1332) according to whether they were accompanied by anemia. The clinical characteristics, cardiac ultrasonic structure and function were analyzed and compared between the 2 groups. The data were analyzed with EmpowerStats statistical software (version 3.0) and R software. According to the data type, independent sample t-test, Kruskal Wallis H test or Chi-square test was used for comparison between groups. Multivariate linear regression model was employed to analyze the influencing factors of hemoglobin (HGB) and the correlation of HGB with cardiac ultrasound indexes. Results The prevalence of anemia was 41.6% (949/2 281) in the elderly HFpEF inpatients. The patients of the anemia group had significantly higher ratio of males [54.69% (519/949) vs 47.75% (636/1332)], older age [(74.79±7.99) vs (73.40±7.72 years], higher systolic blood pressure [(140.06±23.80) vs (136.77±23.05) mmHg (1mmHg=0.133kPa)], increased hospital all-cause mortality [3.58% (34/949) vs 1.50% (20/1 332)], and higher levels of fasting blood glucose [(7.68±3.35) vs (7.02±3.38) mmol/L], N-terminal pro B-type natriuretic peptide [NT-proBNP, 3118.01 (1137.21,8 976.32) vs 1 333.34 (596.32,2 777.11) ng/L] and troponin T [0.04 (0.02,0.08) vs 0.02 (0.01,0.04) μg/L], but lower body mass index [(24.34±4.10) vs (24.87±4.05) kg/m2], HGB level [(9.37±1.65] vs [13.32±1.45) g/dl] and estimated glomerular filtration rate [38.85 (13.98,73.98) vs 76.26 (57.79,95.87) ml/(min · 1.73m2)]when compared with the patients in the control group (all P<0.05). There were statistical differences between the 2 groups in heart function classification and chronic kidney disease (CKD) stage (both P<0.05). Cardiac ultrasound results showed that compared with the control group, the left heart in the anemia group expanded more significantly, with larger left atrial anteroposterior diameter [(41.43±8.13) vs (40.64±7.62 mm], left atrial volume index [29.82(22.55,38.80) vs 28.38(20.55,38.96) ml/m2], left ventricular end systolic diameter [(32.63±4.48) vs (31.64±4.89) mm], left ventricular end diastolic diameter [(46.87±5.78) vs (45.75±6.47) mm], left ventricular end systolic volume [(44.98±23.97) vs (41.15±15.75) ml] and left ventricular end diastolic volume [(103.69±30.07) vs (97.36±31.03) ml]; more significant left ventricular hypertrophy was observed, with increased left ventricular mass index [(120.24±39.99) vs (110.14±36.91) g/m2]and left ventricular posterior wall thickness [(10.68±1.47) vs (10.47±1.52) mm]; the right heart load was aggravated, with widened diameter of the right ventricle [(36.74±7.12) vs (35.90±7.42) mm], diameter of the main pulmonary artery [(22.93±3.40) vs (22.51±3.63) mm] and diameter of the inferior vena cava [(16.89±4.18) vs (16.15±3.93) mm] (all P<0.05). Multiple linear regression analysis indicated that C-reactive protein, NT-proBNP and CKD ≥4 were independent risk factors for lower HGB. Low HGB was an independent risk factor for left ventricular end systolic volume, left ventricular end diastolic volume, left ventricular end systolic diameter, left ventricular end diastolic diameter, left ventricular mass index and left atrial volume index. Conclusion Elderly HFpEF inpatients have a high prevalence of anemia, and cardiac structural remodeling and diastolic dysfunction were more evident in anemic patients. Inflammation and poor cardiac and renal function are independent risk factors for anemia, while anemia is closely related to cardiac structure and functional remodeling.
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