血清白蛋白对射血分数保留型及中间型心力衰竭患者易损期预后的影响
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摘要
目的研究血清白蛋白对射血分数(EF)保留型及中间型心力衰竭(HFpEF和HFmrEF)患者易损期预后的影响。方法连续选取心力衰竭患者151例,其中射血分数保留型(HFpEF)85人,射血分数中间型(HFmrEF)66人;选取同期住院非心力衰竭患者151例作为对照组。收集患者临床资料并进行随访,随访终点事件为全因死亡和心力衰竭再入院。比较两组患者基线资料,并进行单因素Logistics回归分析,确定心力衰竭患者危险因素,对心力衰竭组患者随访结果作Cox回归分析和Kaplan-Meier生存分析以评价血清白蛋白对易损期预后的影响。结果心力衰竭组患者血清白蛋白水平显著低于非心力衰竭患者(t=-6.431,P<0.001),单因素Logistic回归分析结果OR值为0.162(95%CI 0.098～0.268,P<0.001),提示血清白蛋白是HFpEF和HFmrEF患者的保护因素。Cox回归分析和Kaplan-Meier生存分析显示,血清白蛋白与HFpEF和HFmrEF患者易损期的预后有关,其中单因素COX分析HR=0.351,95%CI(0.188～0.655),P=0.001,多因素COX分析HR=0.439, 95%CI(0.225～0.858),P=0.016,均有统计学意义,低白蛋白组和高白蛋白组生存曲线的差异有统计学意义(log-rank检验,χ~2=11.881,P=0.001)。结论血清白蛋白可能是HFpEF和HFmrEF患者的保护因素,血清白蛋白越低,易损期的预后越差。
Aim To study the Influence of albumin in vulnerable phase among ejection fraction retention heart failure and ejection fraction intermediate heart failure(HFpEF and HFmrEF)patients. Methods Continuously selected 151 patients which diagnosed in heart failure in China Medical University(including 85 HFpEF patients and 66 HFmrEF patients). 151 patients with non-heart failure were enrolled in the same period. The patient's clinical data were collected and followed up. Clinical outcomes were defined as all cause mortality and rehospitalization due to worsening HF. Compared baseline data between the two groups, and used univariate logistic regression analysis to determine risk factors for patients with heart failure. Evaluated influence of albumin in vulnerable phase through Cox regression analysis and Kaplan-Meier survival analysis. Results The albumin of HFpEF and HFmrEF patients was obviously higher than non-heart failure patients(t=-6.431,P<0.001). Logistic regression analysis OR 0.162(95%CI 0.098～0.268, P<0.001). Albumin may be the protective factor of HFpEF and HFmrEF. Cox regression analysis and Kaplan-Meier survival analysis showed that serum albumin was associated with vulnerable phase prognosis in patients with HFpEF and HFmrEF. Univariate COX analysis(HR=0.351, 95%CI 0.188～0.655, P=0.001) and multivariate COX analysis(HR=0.439, 95%CI 0.225～0.858, P=0.016) were significant. Kaplan-Meier analysis between higher albumin group and lower albumin group(log-rank:χ~2=11.881,P=0.001)also showed significant difference. Conclusions Serum albumin may be a risk factor for patients with HFpEF and HFmrEF. The lower the serum albumin, the worse the prognosis of the vulnerable period.
Aim To study the Influence of albumin in vulnerable phase among ejection fraction retention heart failure and ejection fraction intermediate heart failure(HFpEF and HFmrEF)patients. Methods Continuously selected 151 patients which diagnosed in heart failure in China Medical University(including 85 HFpEF patients and 66 HFmrEF patients). 151 patients with non-heart failure were enrolled in the same period. The patient's clinical data were collected and followed up. Clinical outcomes were defined as all cause mortality and rehospitalization due to worsening HF. Compared baseline data between the two groups, and used univariate logistic regression analysis to determine risk factors for patients with heart failure. Evaluated influence of albumin in vulnerable phase through Cox regression analysis and Kaplan-Meier survival analysis. Results The albumin of HFpEF and HFmrEF patients was obviously higher than non-heart failure patients(t=-6.431,P<0.001). Logistic regression analysis OR 0.162(95%CI 0.098～0.268, P<0.001). Albumin may be the protective factor of HFpEF and HFmrEF. Cox regression analysis and Kaplan-Meier survival analysis showed that serum albumin was associated with vulnerable phase prognosis in patients with HFpEF and HFmrEF. Univariate COX analysis(HR=0.351, 95%CI 0.188～0.655, P=0.001) and multivariate COX analysis(HR=0.439, 95%CI 0.225～0.858, P=0.016) were significant. Kaplan-Meier analysis between higher albumin group and lower albumin group(log-rank:χ~2=11.881,P=0.001)also showed significant difference. Conclusions Serum albumin may be a risk factor for patients with HFpEF and HFmrEF. The lower the serum albumin, the worse the prognosis of the vulnerable period.
引文
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[5] Bavishi C,Ather S,Bozkurt B,et al.Prognostic significance of hypoalbuminemia among ambulatory heart failure patients with reduced and preserved ejection fraction[J].Circulation,2013,128:A16960.
[6] 宋娇磊,于彤彤,刘双双,等.低白蛋白对老年慢性心力衰竭患者长期预后的影响[J].中国动脉硬化杂志,2016,24(2):187-192.
[7] 董玲玲,宫丹丹,郑黎强,等.血清白蛋白水平对慢性心力衰竭发生及预后的意义[J].中国动脉硬化杂志,2013,21(9):817-821.
[8] 韩悦媛,季亢挺.舒张性心力衰竭的研究进展[J].医学综述,2017,23(23):4649-4653.
[9] 李佩雯,任洁.心力衰竭易损期患者院外管理的价值[J].中西医结合心血管病电子杂志,2018,6(4):7-10.
[10] MacDonald MR,Petrie MV,Varyani F,et al.Impact of diabetes on outcomes in patients with low and preserved ejection fraction heart failure:an analysis of the candesartan in heart failure:assessment of reduction in mortality and morbidity (CHARM) programme[J].Eur J Heart Fail,2008,29(11):1377-1385.
[11] Arques S,Ambrosi P.Human serum albumin in the clinical syndrome of heart failure[J].J Card Fail,2011,17(6):451-458.
[12] Ancion A,Allepaerts S,Oury C,et al.Serum albumin level and hospital mortality in acute non-ischemic heart failure[J].ESC Heart Fail,2017,4(2):138-145.
[2] Greene SJ,Fonarow GC,Vaduganathan M,et al.The vulnerable phase after hospitalization for heart failure[J].Nat Rev Cardiol,2015,12(4):220-229.
[3] Liu M,Chan CP,Yan BP,et al.Albumin levels predict survival in patients with heart failure and preserved ejection fraction[J].Eur J Heart Fail,2012,14(1):39-44.
[4] Horwich TB,Zadeh KK,MacLellan RW,et al.Albumin levels predict survival in patients with systolic heart failure[J].Am J Hypertens,2008,155(5):883-888.
[5] Bavishi C,Ather S,Bozkurt B,et al.Prognostic significance of hypoalbuminemia among ambulatory heart failure patients with reduced and preserved ejection fraction[J].Circulation,2013,128:A16960.
[6] 宋娇磊,于彤彤,刘双双,等.低白蛋白对老年慢性心力衰竭患者长期预后的影响[J].中国动脉硬化杂志,2016,24(2):187-192.
[7] 董玲玲,宫丹丹,郑黎强,等.血清白蛋白水平对慢性心力衰竭发生及预后的意义[J].中国动脉硬化杂志,2013,21(9):817-821.
[8] 韩悦媛,季亢挺.舒张性心力衰竭的研究进展[J].医学综述,2017,23(23):4649-4653.
[9] 李佩雯,任洁.心力衰竭易损期患者院外管理的价值[J].中西医结合心血管病电子杂志,2018,6(4):7-10.
[10] MacDonald MR,Petrie MV,Varyani F,et al.Impact of diabetes on outcomes in patients with low and preserved ejection fraction heart failure:an analysis of the candesartan in heart failure:assessment of reduction in mortality and morbidity (CHARM) programme[J].Eur J Heart Fail,2008,29(11):1377-1385.
[11] Arques S,Ambrosi P.Human serum albumin in the clinical syndrome of heart failure[J].J Card Fail,2011,17(6):451-458.
[12] Ancion A,Allepaerts S,Oury C,et al.Serum albumin level and hospital mortality in acute non-ischemic heart failure[J].ESC Heart Fail,2017,4(2):138-145.