血清LDL-C水平与老年射血分数降低性心衰患者预后的关系

Prognostic significance of serum low-density lipoprotein cholesterol levels in elderly patients hospitalized for heart failure with reduced ejection fraction

目的：研究血清低密度脂蛋白胆固醇（LDL - C）水平对老年住院射血分数降低性心力衰竭（HFrEF）患者长期预后的影响。方法本研究为单中心回顾性研究。选取2007年8月至2012年2月于郑州大学人民医院住院治疗的不同病因的340例老年 HFrEF 患者，依据血清 LDL - C 水平分为3组：低水平 LDL - C 组（LDL - C≤2.2667 mmol/ L），中等水平 LDL - C 组（LDL - C≤2.8733 mmol/ L），高水平 LDL - C 组（LDL - C ﹥2.8733 mmol/ L），分析各组全因死亡率差异，采用多因素 Cox 比例风险回归模型分析不同水平 LDL - C 对全因死亡率的影响。结果340例患者中共116例发生全因死亡。其中高水平 LDL - C 组全因死亡率为23.89%，低于中等水平 LDL - C 组36.09%及低水平 LDL - C 组43.36%（P ﹤0.05）。Kaplan - Meier 生存曲线显示高水平 LDL - C 组全因死亡低于其余2组（Log Rank =12.595，P =0.002）。根据多因素 Cox 比例风险模型，低水平 LDL - C 组患者全因死亡率是高水平 LDL - C 组患者的2.135倍（95%CI：1.311~3.477，P =0.002）。结论高水平的 LDL - C 与老年住院 HFrEF 患者长期全因死亡率降低有关。

Objective To observe the long - term relationship between levels of low - density lipoprotein cholesterol and post - discharge mortality among elderly patients hospitalized for heart failure with reduced ejection fraction（HFrEF）. Methods This study was a single - center retrospective study. A total of 340 elderly HFrEF patients were included from August of 2007 to February of 2012. The cohort was divided into tertiles according to LDL - C levels：the low LDL - C level group（LDL - C≤2. 2667 mmol/ L）,the moderate LDL - C level group（ LDL - C 2. 873 3 mmol/ L ≤ ）and the high LDL - C level group（LDL - C ﹥2. 873 3 mmol/ L）. All - cause mortalities were compared. The impact of the different levels of LDL - C on all - cause mortality was analyzed by using multiariable Cox proportional hazards regression model. Results There were 116 all - cause deaths. All - cause mortality in the high LDL - C level group（23. 89%） was significantly lower than the moderate LDL - C level group（ 36. 09%）and the low LDL - C level group（ 43. 36%）. Kaplan - Meier curves showed the all - cause mortality was lower in the high LDL - C level group than in the other two groups. According to the Cox proportional hazards regression model,the patients in the low LDL - C level group had a hazard ratio of all - cause death of 2. 135（95%CI：1. 311 ~3. 477,P = 0. 002）compared to those with high LDL - C level. Conclusion The high LDL - C levels were associated with a reduced post - discharge mortality among elderly patients hospitalized for HFrEF.