射血分数正常心力衰竭患者241例临床分析

Clinical analysis of patients with heart failure and normal left ventricular ejection fraction

目的:对比分析心力衰竭(HF)患者中左心室射血分数正常者(HFNEF)与射血分数降低(SHF)患者的临床和心脏结构的特点。方法:选择我院心内科连续收治,符合研究条件者共241例,其中HFNEF 88例,SHF153例,分析其病因、心脏结构特点和HF危险因素。结果:与SHF患者相比,HFNEF患者的年龄较大[(75.43±10.43)岁比(80.25±7.74)岁],女性患者较多(占78.4%),P均<0.001。HFNEF患者的直接病因以高血压病(33.0%)、冠心病(25.0%)最多见,SHF患者的最常见病因为冠心病,尤其是陈旧性心肌梗死患者。HF-NEF患者中心房颤动的患病率较高,左心室肥厚多见(P均<0.001),但左心室重构的程度较轻;SHF患者血清N末端脑钠肽前体水平显著降低(P<0.001),肌酐水平亦降低(P<0.05)。结论:心力衰竭左心室射血分数正常患者多为老年女性,主要病因中以高血压和冠心病最多,左室肥厚和房颤的患病率高。

Abstract： Objective： To compare and analyze clinical and cardiac structural characteristics between patients with heart failure （HF） and normal left ventricular ejection fraction （HFNEF） and systolic HF （SHF） patients. Methods： A total of 241 acute or chronic HF patients were enrolled continuously, including 88 HFNEF cases and 153 SHF cases. Causes, characteristics of cardiac structure and risk factors for HF were compared between the two groups. Results： Compared with SHF patients, HFNEF patients were older [（75.43±10.43） years vs. （80.25±7.74） years], and female patients were more （78.4%）, P〈0. 001 all. Hypertension （33.0%） and coronary heart disease （CHD, 25.0%） were most direct causes for HFNEF; it＇s CHD, especially old myocardial infarction for SHF patients. In HFNEF patients, incidence rate of atrial fibrillation was higher, left ventricular hypertrophy was more （P〈0. 001）, but remodeling degree of left ventricular was mild. Levels of N--terminal pro brain natriuretic peptide （NT proBNP） signifi- cantly decreased （P〈0. 001）, creatinine was lower （P〈0. 05） in HFNEF patients. Conclusion： For HFNEF patients, there are more female, aged patients, hypertension, atrial fibrillation, and left ventricular hypertrophy; hypertension and CHD are its major causes.