血液净化治疗顽固性心力衰竭患者的预后研究

Study on prognosis of refractory heart failure patients treated with blood purification therapy

目的探讨血液净化治疗对顽固性心力衰竭患者预后的影响。方法选取2013年3月～2015年2月在新疆石河子市人民医院住院的心力衰竭患者40例，根据患者意愿，分为血液净化联合常规药物治疗组（试验组）与常规药物治疗组（对照组）各20例。观察2组治疗前后血尿素氮（BUN）、血肌酐（Scr）、氨基末端 B 型脑钠肽前体（amino-terminal pro-B-type natriuretic peptide，NT-proBNP）、左心室射血分数（LVEF），随访观察患者再住院及生存状况。结果2组治疗48h后：试验组BUN、Scr下降（P＜0.01），对照组 BUN、Scr 升高（P＜0.05），且试验组 BUN、Scr 低于对照组（P＜0.05）；两组 LVEF 均较治疗前升高（P＜0.01），试验组LVEF的升高幅度大于对照组（P＜0.001）；NT-proBNP均下降（与治疗前比较， P＜0.001），试验组下降率超过对照组（P＜0.001）。随访90天内，与对照组相比，试验组再入院率降低（P=0.027）、再住院次数减少（P＜0.05）、出院后首次再入院间隔天数延长（P＜0.05）。至随访终止日期2015年5月1日，试验组中位生存时间为171.5天，对照组中位生存时间为102.5天，应用Kaplan-Meier生存曲线及Log-rank检验显示试验组具有生存优势（P=0.031）；单因素COX回归分析显示，血液净化治疗可降低患者死亡风险[HR=0.396，95%CI（0.166～0.946），P=0.031]。结论血液净化治疗可改善顽固性心力衰竭患者再住院相关指标及生存状况。

Objective To study the effect of blood purification therapy on the prognosis of patients with refractory heart failure. Methods Forty refractory heart failure patients treated in Xinjiang Shihezi People＇s Hospital during the period from March 2013 to February 2015 were enrolled and assigned into blood purifica-tion combined with conventional medical treatment （experimental group, n=20） or conventional medical treat-ment （control group, n=20） according to patients’preferences. Blood urea nitrogen （BUN）, serum creatinine （Scr）, NT-proBNP （amino-terminal pro-B-type natriuretic peptide）, and LVEF （left ventricular ejection frac-tion） were determined before and after the treatment. Readmission rate and survival status were also recorded. Results After the treatment for 48 hours, BUN and Scr in the experimental group decreased as compared with those at the initial period （P〈0.01）; BUN and Scr in the control group increased as compared with those at the initial period （P〈0.05） and those in the experimental group （P〈0.05）. The increase of LVEF was ob-served in both group （P〈0.01）, but the rate of increase was more in the experimental group than in the con-trol group （P〈0.001）. NT-proBNP decreased in both groups as compared with that before the treatment （P〈0.001）, but the rate of decline was more in the experimental group than in the control group （P〈0.001）. In the follow-up period of 90 days, readmission rate and the number of readmission were lower （P〈0.05）, and the period between discharge from the hospital and the first readmission was longer （P〈0.05） in the experimental group as compared with those in the control group. At the end of follow-up period （May 1, 2015）, the median survival time was 171.5 days in the experimental group and was 102.5 days in the control group. Kaplan-Mei-er survival curve and Log-rank test demonstrated that patients in the experimental group had survival advan-tage （P=0.031）. Univariate Cox regression analysis showed that blood purification therapy reduced the risk of death （HR=0.396, 95% CI 0.166~0.946, P=0.031）. Conclusion Blood purification therapy decreased the readmission rate and improved survival status in patients with refractory heart failure.