射血分数降低的急性心力衰竭患者的临床特点及危险因素分析

Analysis of Clinical Characteristics and Risk Factors for Acute Heart Failure Patients with Reduced Ejection Fraction

摘要: 目的：分析左心室射血分数(LVEF)降低的急性心力衰竭(AHF)患者的临床特点及危险因素。方法：选取浙江省人民医院2019年1月至2020年1月首次入院的AHF患者162例，根据LVEF将患者分为2组，其中LVEF ≤ 40%为射血分数降低组，共94例，LVEF ≥ 50%为射血分数保留组，共68例。记录上述患者基础资料及实验室指标，并随访1年，记录随访期内再住院及死亡人数。比较两组患者的临床资料，采用多因素logistic回归分析射血分数降低的AHF患者的临床特点及再住院的危险因素。结果：射血分数降低组AHF患者收缩压、尿酸、高密度脂蛋白胆固醇均明显低于射血分数保留组的AHF患者(均P < 0.05)，舒张压、心率、糖化血红蛋白A1、白蛋白、脑利钠肽、脑钠素N端前体肽、肌钙蛋白I水平均明显高于射血分数保留组的AHF患者(均P < 0.05)；射血分数降低组AHF患者再住院率及1年内死亡率高于射血分数保留组(均P < 0.05)。多因素logistic回归分析发现性别、年龄、心率、白蛋白、糖化血红蛋白A1、脑利钠肽是影响射血分数降低的AHF患者再住院的独立危险因素(均P < 0.05)。结论：左心室射血分数减少的AHF患者的1年内预后较射血分数保留的AHF患者差，临床上应加强对该类患者的随访，改善血压、心率的控制水平，定期监测白蛋白、糖化血红蛋白A1、脑利钠肽、脑钠素N端前体肽水平，降低再住院及死亡率。

Abstract: Objective: Analysis of clinical characteristics and risk factors for acute heart failure (AHF) patients with reduced ejection fraction. Methods: The AHF patients admitted to Zhejiang Provincial People’s Hospital from January 2019 to January 2020 were selected and divided into a reduced ejection fraction group of 94 cases and a reserved ejection fraction group of 68 cases according to the number of admissions. The above patient basic information and laboratory indicators were recorded, followed up for 1 year, recorded in the recycling period and the number of deaths during the period. The clinical data of the two groups of patients were compared and used multivariate logistic regression to analyze influencing factors of rehospitalization of AHF patients with reduced ejection fraction. Results: The systolic blood pressure, uric acid and high density lipoprotein cholesterol of the reduced ejection fraction group were significantly lower than those of the reserved ejection fraction group (all P < 0.05). Diastolic blood pressure, heart rate, glycated hemoglobin A1, albumin, brain sodium peptide, sodium sodium N-end peptide, troponin I of the reduced ejection fraction group were significantly higher than those of the reserved ejection fraction group (all P < 0.05). The rehospitalization rate and the one-year mortality in the 1 year of the mortality of AHF patients in reduced ejection fraction group were higher than that of reserved ejection fraction group (P < 0.05). Multivariate logistic regression analysis shows that gender, age, heart rate, albumin, glycalated hemoglobin A1, brain sodium peptide are independent risk factors that affect the rehospitalization of AHF patients in reduced ejection fraction group. Conclusion: Acute heart failure patients with reduced ejection fraction have poor prognosis within 1 year than patients with reserved ejection fraction. The clinical should strengthen the follow-up of this class and improve blood pressure, heart rate control level, regular monitoring albumin, glycated hemoglobin A1, brain sodium peptide, sodium sodium N-ternary peptide level, reducing re-hospitalization and mortality.