影响老年慢性心力衰竭预后的多因素分析

Analysis of influencing factors on survival in elderly patients with chronic heart failure

目的分析老年慢性心力衰竭患者远期预后(生存情况)的影响因素,为制定防治策略,提高其生存率提供科学依据。方法入选在我院住院的298例慢性心力衰竭患者,对其20个暴露因素进行单因素和多因素COX模型分析。结果单因素分析显示,患病年龄、多病因、纽约心功能分级(NYHA)、氨基末端脑钠肽前体(NT-proBNP)、左心室射血分数(LVEF)、血管紧张素转换酶抑制剂(ACEI)和β受体阻滞剂使用6个因素对患者预后影响有统计学意义(相对危险RR分别为3.007,2.354,2.283,4.385,1.381,0.721,0.506;95%可信区间分别为1.589～5.675,1.178～4.704,1.534～4.617,1.900～10.121,1.573～3.212,0.562～0.837,0.283～0.905;各指标P<0.05)。其中ACEI和β受体阻滞剂使用为保护因素(RR<1)。多因素分析显示,年龄、多病因、NT-proBNP、β受体阻滞剂使用4个因素对心力衰竭患者的生存有影响(RR分别为2.683,2.953,2.469,0.628;95%可信区间分别为1.344～5.355,1.456～5.987,1.032～5.912,0.463～0.958;各指标P<0.05)。结论年龄增加、多病因、NT-proBNP升高、未使用β受体阻滞剂是影响老年心力衰竭患者生存的独立危险因素。

Objective To investigate the influencing factors on survival in elderly patients with chronic heart failure. Methods A total of 298 patients with chronic heart failure were enrolled in this study and 20 exposure factors were analyzed by univariate and multivariate COX model. Results Univariate analysis showed that age, multiple etiologies, NYHA classification, NT-proBNP, LVEF, ACEI and beta-blocker using have significant influence on prognosis of patients with heart failure （RR was 3. 007, 2. 354, 2. 283, 4. 385, 1. 381, 0. 721 and 0. 506, respectively, and 95% CI 1. 589- 5. 675, 1. 178-4. 704, 1. 534-4. 617, 1. 900-10. 121, 1. 573-3. 212,0. 562-0. 837 and 0. 283-0. 905, respectively, all P 〈 0. 05 ）. Multivariate analysis showed that age, multiple etiologies, NT-proBNP, beta blockers using have significant independent influence on survival of patients with heart failure （ RR was 2. 683, 2. 953, 2. 469 and 0. 628 respectively, with 95% CI 1. 344-5. 355, 1. 456-5. 987, 1. 032-5. 912 and 0. 463-0. 958, respectively, all P 〈 0. 05 ）. Conclusions Age, etiology, NT-proBNP, beta blockers using are independent influencing factors of survival in elderly patients with chronic heart failure.