射血分数保留型与减低型心力衰竭患者的临床特点分析

Clinical characteristics of patients with preserved ejection fraction and reduced heart failure

目的 比较射血分数保留型与射血分数减低型心力衰竭（以下简称心衰）的临床特点.方法回顾性分析2015年9月至2017年11月山西医科大学第二医院收治入院的心力衰竭患者171例的临床资料,按左心室射血分数（EF 值）分为射血分数保留型心衰组[HFPEF组,EF≥45%,84 例,年龄（64.8 ± 2.2）岁,其中男性33例,女性51例]和射血分数减低型心衰组[HFREF组,EF＜45%,87例,年龄（74.6 ± 1.5）岁,其中男性61例,女性26例],详细记录相关临床指标,包括一般资料、基础病因、生化指标、超声心动图结果、用药情况等,比较两组的临床资料.结果 171例患者中冠心病患者69例,扩心病患者44例,高心病患者21例,肺心病患者10例,风心病患者15例,退行性瓣膜病患者7例,先天性心脏病2例,房颤所致心衰患者2例,病毒性心肌炎患者1例. HFPEF组年龄[（74.6 ±1.5）岁比（64.8 ±2.2）岁,t＝3.598,P＝0.015]、入院收缩压均高于HFREF组[（131.2 ±22.2）mmHg比（124.1 ±24.9）mmHg,t＝2.058,P＝0.041],且女性患者所占比例偏高（60.7%比29.9%,χ2＝16.410,P＝0.000）;与HFREF组相比,HFPEF组体质量低[（62.7 ± 13.4）kg比（68.6 ±14.9）kg,t＝－2.395,P＝0.018]、合并高血压（54.8%比37.9%,χ2＝4.871,P＝0.032）、房颤（47.6%比13.8%,χ2＝23.107,P＝0.000）的比例大,合并肾功能不全比例小（36.7%比53.6%,χ2＝4.670,P＝0.041）;生化指标中,HFPEF 组较 HFREF 组 BNP 值[（874.2 ±912.3） pg/mL 比（1 835.2 ± 1 490.4）pg/mL,t＝－5.011,P ＝0.000]和血红蛋白值[（125.5 ±24.3） g/L 比（134.7 ±23.9） g/L,t ＝－2.460,P＝0.015]低、红细胞沉降率快[（28.0 ±25.6）mm/h比（16.9 ±14.9）mm/h,t＝2.486,P＝0.017];HFPEF组左心室较HFREF组小[（50.9 ±6.4）mm比（67.3 ±8.5）mm,t＝－11.303,P＝0.000];HFPEF组RAS阻断剂（52.4%比86.2%,χ2＝23.107,P＝0.000）、螺内酯（72.6%比88.5%,χ2＝6.926,P＝0.011）、β受体阻滞剂（57.1%比75.9%,χ2＝6.739,P＝0.015）、他汀类药物（38.1%比54%,χ2＝4.362,P＝0.046）的使用率均不如HFREF组频繁,而钙通道阻滞剂（38.1%比13.8%,χ2＝13.208,P＝0.000）和华法林（16.7%比5.7%,χ2＝5.159,P＝0.129）的使用较多.结论 射血分数保留型心衰和射血分数减低型心衰存在诸多差异,不同类型的心衰需采取不同的诊治及预防方案.

Objective To compare the clinical characteristics of heart failure patients with preserved ejection fraction （HFPEF） and reduced ejection fraction （HFREF）.Methods A total of 171 patients with heart failure from September 2015 to November 2017 in the Second Hospital of Shanxi Medical University were retrospectively analyzed . According to left ventricular ejection fraction （EF）,the patients were divided into two groups ： HEPEF [EF≥45%, 84 cases,mean age （64.8 ±2.2）years old,33 males and 51 females] and HFREF （EF〈45%,87 cases,mean age （74.6 ±1.5） years old,including 61 males and 26 females）.The clinical data of the two groups including general information,underlying etiology,biochemical indicators,echocardiography results,medication in detail were recorded. Results Among the 171 patients, there were 69 patients with coronary heart disease , 44 patients with dilated cardiomyopathy,21 patients with hypertensive heart disease ,10 patients with pulmonary heart disease ,15 patients with rheumatic heart disease,7 patients with degenerative valvular disease ,2 patients with congenital heart disease ,2 cases of heart failure caused by atrial fibrillation ,1 case of viral myocarditis .The patients in the HFPEF group were older [（74.6 ±1.5）years old vs.（64.8 ±2.2） years old,t=3.598,P=0.015],more women（60.7%vs.29.9%,χ2=16.410,P=0.000）,lower body weight [（62.7 ±13.4） kg vs.（68.6 ±14.9） kg,t =-2.395,P=0.018],less likely to have renal insufficiency（36.7%vs.53.6%,χ2=4.670,P=0.041）,and more likely to have hypertension （54.8%vs.37.9%,χ2=4.871,P=0.032） and atrial fibrillation（47.6% vs.13.8%,χ2=23.107,P=0.000）. The HFPEF group had higher admission systolic blood pressure than the HFREF group [（131.2 ±22.2）mmHg vs. （124.1 ±24.9）mmHg,t=2.058,P=0.041].The BNP value[（874.2 ±912.3） pg/mL vs.（835.2 ±1 490.4）pg/mL,t=-5.011,P=0.000],hemoglobin value[（125.5 ±24.3）g/L vs.（134.7 ±23.9）g/L,t=-2.460,P=0.015] in the HFPEF group were lower than those in the HFREF group .The ESR in the HFPEF group was faster than that in HFREF group[（28.0 ±25.6）mm/h vs.（16.9 ±14.9）mm/h,t=2.486,P=0.017].The HFPEF group had smaller left ventricular size than the HFREF group [（50.9 ±6.4）mm vs.（67.3 ±8.5）mm,t=-11.303,P=0.000].RAS blockers （52.4% vs.86.2%,χ2=23.107,P =0.000）,spironolactone （72.6% vs.88.5%,χ2=6.926,P =0.011）,β-blockers （57.1% vs.75.9%,χ2=6.739,P =0.015）,statin （38.1% vs.54%,χ2=4.362,P=0.046） were used more in the HFREF group,while calcium channel blockers （38.1%vs.13.8%,χ2=13.208,P=0.000） and warfarin （16.7%vs.5.7%,χ2=5.159,P=0.129） were used more in the HFPEF group.Conclusion Different clinical characteristics were found in patients with HFPEF and HFREF ..Different types of heart failure need different treatment and prevention programs .