不同病因心衰患者低密度脂蛋白水平和全因死亡率的关系

Relation between LDL levels and mortality in patients with different causes of HF

目的目前研究显示低密度脂蛋白(LDL)水平会增加心衰患者的死亡率,此次研究希望评价心衰患者LDL水平和预后这种关系是否会因心衰病因不同而改变(缺血性VS非缺血性)。方法纳入的413例数据完整且射血分数(ejection fraction,EF)≤50%的心衰患者,进行回顾性研究。病例按LDL水平等分为三组(T1<2.01,2.01≤T2<2.72,T3≥2.72 mmol/L),分别进行单因素的Kaplan–Meier法生存分析与多因素的COX回归分析。结果在缺血性和非缺血性心衰患者间,性别、脉压差、左室舒张期内径(left ventricular end diastolic diameter,LVDd)、血管紧张素转化酶抑制剂(angiotensin converting enzyme inhibitior,ACEI)、糖尿病、高血压、房颤等基线水平差异有统计学意义。多因素的COX回归分析显示:缺血性心衰患者以T3为对照,T1、T2的风险比(hazard ratio,HR)分别为4.062[1.528-5.713,P=0.002]、1.510[1.091-3.519,P=0.362];非缺血性心衰患者T1、T2的风险比分别为2.954[1.687-9.78,P=0.001]、1.960[0.622-3.665,P=0.024]。结论无论是缺血性还是非缺血性心衰患者,在调整其它危险因素后,LDL依旧为独立预后预测因素,低水平LDL会降低其生存时间。

Objective This study aimed to examine whether the impact of levels of low-density lipoprotein cholesterol（ LDL-c） on mortality in HF patients is associated with HF etiology（ ischemic vs. non-ischemic） in a cohort of HF patient. Methods Totally 413 HF patients with left ventricular ejection fraction（ EF） ≤50% who were eligible for analysis were collected to follow up. Patients were stratified into Tertile of LDL（ T1 〈 2. 01,2. 01≤T2 2. 72,T3≥2. 72 mmol/L）. Results Sex,pulse pressure,left ventricular end diastolic diameter（ LVDd）,angiotensin converting enzyme inhibitior（ ACEI）,diabetes mellitus,hypertension and atrial fibrillation existence statistics difference between ischemic and non-ischemic patients. Using T3 as a reference,hazard ratios for T1,T2 were 4. 062 [1. 528-5. 713,P = 0. 002]and 1. 510[1. 091-3. 519,P = 0. 362],respectively,for ischemic patients and 2. 954[1. 687-9. 78,P = 0. 001] and1. 960[0. 622-3. 665,P = 0. 024],respectively,for ischemic patients. After adjusting forrisk factors,LDL remained an independent predictor of survivalin non-ischemic patients. Conclusion Low LDL-c levels are associated with a reduced survival in HF patients both in ischemic and non-ischemic HF