入院时总胆红素水平对维吾尔族住院心力衰竭患者短期预后的影响研究

Impact of Total Bilirubin at Admission on Short-term Prognosis in Uygur Inpatients with Heart Failure

目的探讨入院时总胆红素(TBi L)水平对维吾尔族住院心力衰竭患者短期预后的影响。方法选取2013—2016年新疆维吾尔自治区人民医院收治的维吾尔族心力衰竭患者300例,根据入院时TBi L水平分为正常组154例(TBi L水平<17.1μmol/L)和升高组146例(TBi L水平≥17.1μmol/L)。通过查阅患者病历资料而记录其年龄、性别、体质指数、心率、收缩压、舒张压、冠心病发生情况、心律失常发生情况、糖尿病发生情况、高血压发生情况、纽约心脏病协会(NYHA)分级、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、QRS时限、入院时抗心力衰竭药物使用情况及实验室检查指标。绘制两组患者全因死亡和心血管死亡的Kaplan-Meier生存曲线;维吾尔族住院心力衰竭患者全因死亡和心血管死亡的影响因素分析采用多因素Cox回归分析。结果两组患者年龄、性别、体质指数、冠心病发生率、心律失常发生率、糖尿病发生率、高血压发生率、LVEDD、LVEF、QRS时限比较,差异无统计学意义(P>0.05);升高组患者心率快于正常组,收缩压和舒张压低于正常组,NYHA分级劣于正常组,入院时使用利尿剂和血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)者所占比例高于正常组(P<0.05)。两组患者血红蛋白(Hb)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、血肌酐(Scr)、脑钠肽(BNP)水平比较,差异无统计学意义(P>0.05);升高组患者白细胞计数(WBC)及C反应蛋白(CRP)、尿素氮(BUN)、血尿酸(SUA)、空腹血糖(FPG)高于正常组,清蛋白(Alb)低于正常组(P<0.05)。绘制Kaplan-Meier生存曲线显示,随访1年,升高组患者全因死亡的Kaplan-Meier生存曲线劣于正常组,心血管死亡的Kaplan-Meier生存曲线劣于正常组(P<0.05)。多因素Cox回归分析结果显示,TBi L是维吾尔族住院心力衰竭患者全因死亡的独立影响因素[HR=1.028,95%CI(1.009,1.048),P<0.05];TBi L是维吾尔族住院心力衰竭患者心血管死亡的独立影响因素[HR=1.024,95%CI(1.004,1.044),P<0.05]。结论入院时TBi L水平升高的维吾尔族住院心力衰竭患者病情较严重、预后较差,且入院时TBi L水平是患者短期预后的独立影响因素。

Objective To investigate the impact of total bilirubin(TBiL)at admission on short-term prognosis in Uygur inpatients with heart failure.Methods A total of 300 Uygur inpatients with heart failure were selected in the People's Hospital of Xinjiang Uygur Autonomous Region from 2013 to 2016,and they were divided into A group(with TBiL equal or less than 17.1μmol/L,n=154)and B group according to TBiL(with TBiL equal or over 17.1μmol/L,n=146)at admission.Medical records were looked up to collect related information,including age,gender,BMI,heart rate,SBP,DBP,incidence of coronary heart disease,arrhythmia,diabetes and hypertension,NYHA grade,LVEDD,LVEF,QRS duration,usage of anti-heart failure drugs at admission and laboratory examination results.Kaplan-Meier survivorship curve for all-cause mortality and cardiovascular mortality was drawn and compared between the two groups,respectively;multivariate Cox regression analysis were used to analyze the influencing factors of all-cause mortality and cardiovascular mortality in Uygur inpatients with heart failure.Results No statistically significant differences of age,gender,BMI,incidence of coronary heart disease,arrhythmia,diabetes or hypertension,LVEDD,LVEF or QRS duration was found between the two groups(P>0.05);heart rate in B group was statistically significantly faster than that in A group,SBP and DBP in B group were statistically significantly lower than those in A group,NYHA grade in B group was statistically significantly worse than that in A group,while proportion of patients using diuretic and ACEI/ARB at admission in B group was statistically significantly higher than that in A group,respectively(P<0.05).No statistically significant differences of Hb,TG,TC,HDL,LDL,Scr or BNP was found between the two groups(P>0.05);WBC,CRP,BUN,SUA and FPG in B group were statistically significantly higher than those in A group,while Alb in B group was statistically significantly lower than that in A group(P<0.05).Kaplan-Meier survivorship curve showed that,survivorship curve for all-cause mortality and cardiovascular mortality in B group was statistically significantly worse than that in A group during the 1-year follow-up,respectively(P<0.05).Multivariate Cox regression analysis results showed that,TBiL was one of independent influencing factors of all-cause mortality〔HR=1.028,95%CI(1.009,1.048),P<0.05〕and cardiovascular mortality〔HR=1.024,95%CI(1.004,1.044),P<0.05〕in Uygur inpatients with heart failure.Conclusion The illness state is relatively serious and the prognosis is relatively poor in Uygur heart failure inpatients with elevated TBiL at admission,and TBiL at admission is one of influencing factors of the short-term prognosis.