老年冠心病心力衰竭患者预后与血脂的相关性分析

Analysis of the correlation of the prognosis and blood lipids of heart failure in patients with coronary heart disease

目的探讨老年冠心病心力衰竭患者预后与血脂水平之间的相互关系。方法将720例老年冠心病心力衰竭患者按照随访觌的存活状况分成存活组和死亡组，比较两组患者的血脂水平，利用多因素Cox回归分析探讨血脂对老年冠心病患者心力衰竭预后的影响。结果死亡组的年龄、陈旧性心肌梗死、房颤、贫血的发生概率明显高于存活组（X2=5．626、4．597、5．632、6．461，均P〈0．05），HDL．C、EF、ACEI／ARB及他汀类药物比例明显低于存活组（分别t=10．725、9．563、8．457、9．170，P〈0．05或P〈0．01）血管紧张素转换酶抑制剂（ACEI）／血管紧张素II受体拮抗剂（ARB）有利于改善预后（r=0．678，P〈0．01），而低水平和较低水平的HDL．C、NYHAHI—IV级、年龄是危险因素（r=1．052、2．298、2．586，均P〈0．01）。结论HDL-C与老年冠心病患者心力衰竭预后存在密切联系，为改善患者的预后，可以设法适当提升HDL—C水平。

Objective To investigate the relationship between the prognosis of patients with coronary heart disease in elderly heart failure between lipid levels. Methods 720 cases of coronary heart disease in elderly patients with heart failure, according to the survival of the follow-up period were divided into survival group and death group, comparing lipid levels in each group of patients, the use of multivariate Cox regression analysis to investigate the effects of lipids in elderly patients with heart failure, coronary artery disease prognosis. Results Age group of death, old myocardial infarction （OMI）, the probability of occurrence of atrial fibrillation, anemia was significantly higher than that of the survival group（ X2 = 5. 626,4. 597,5. 632,6. 461, all P 〈 0.05 ）, HDL-C, EF, ACEI/ARB and statins was significantly lower than those of the survival group（ t = 10. 725,9. 563,8. 457,9. 170 ,P 〈 0.05 or P 〈 0.01 ）. An- giotensin-converting enzyme inhibitors（ ACEI） /angiotensin Ⅱ receptor antagonists（ARB） would help to improve the prognosis（ r = 0. 678 ,P 〈 0. 01 ） , whereas low levels and low levels of HDL-C, NYHA Ⅲ-grade IV, age was a risk fae- tor（r =1.052,2.298,2.586,all P〈0. 01）. Conclusion There is a close contact between HDL-C and prognosis of heart failure in elderly patients with coronary heart disease,in order to improve the prognosis of patients,it ean be ap- propriately managed to elevate HDL-C levels.