老年射血分数中间值心力衰竭患者的不同体质指数表型特点及预后分析

Phenotypic characteristics and prognosis of different body mass index in patients with heart failure and median ejection fraction

目的比较不同体质量指数(BMI)的射血分数中间值心力衰竭(HFmrEF)患者的临床特点及预后。方法纳入2016年1月至2017年6月彭州市人民医院老年医学科年龄> 60岁的HFmrEF(LVEF40%～50%)住院患者226例,按照BMI值分为正常组(18.5 kg/m2<BMI <24 kg/m2,106例)、超重组(24 kg/m2≤BMI <28 kg/m2,71例),肥胖组(BMI≥28 kg/m2,49例),观察记录三组患者的临床特征、住院病死率以及患者出院后随访12个月的主要心血管不良事件。结果与正常组比较,肥胖组年龄偏小、女性患者更多,甘油三酯更高,吸烟者更少,收缩压、舒张压、心率、血红蛋白、白蛋白更高,胆红素、高密度脂蛋白更低,合并高血压、糖尿病更多,入院时水肿症状更多见,使用地高辛更多,贫血、COPD更少,高脂血症更多,住院时间较长、住院期间全因病死率、随访1年再次住院更高(均P <0.05)。与超重组相比,肥胖组年龄偏小、女性患者更多,甘油三酯更高,吸烟者更少,合并高血压、糖尿病更多,入院时水肿症状更多见,使用地高辛更多,住院时间较长,随访1年再次住院更高(均P <0.05)。结论老年HFmrEF中肥胖表型的患者近期、远期预后较差,老年HFmrEF肥胖表型具有不同于正常、超重表型的临床特点,可能需要采用不同的防治策略。

Objective To compare the clinical features and prognosis of patients with heart rate fraction(HFmrEF)with different body mass index(BMI).Methods A total of 226 inpatients with HFmrEF(LVEF 40%~50%)aged>60 years in the Department of Geriatrics in Pengzhou People′s Hospital during January 2016 to June 2017 were enrolled into the normal group(18.5<BMI<24,106 cases),super-recombination group(24≤BMI<28,71 cases)and obesity group(BMI≥28,49 cases).The clinical characteristics of the three groups of patients,hospital mortality and major cardiovascular adverse events after 12-month follow-up after discharge were recorded.Results Compared with the normal group,patients in the obese group were younger,with more female,with higher triglycerides,fewer smokers,systolic blood pressure,diastolic blood pressure,heart rate,hemoglobin,higher albumin,bilirubin and higher density.Lower lipoprotein,hypertension,diabetes,more edema symptoms on admission,more digoxin,less anemia,less COPD,more hyperlipidemia,longer hospital stay,all-cause during hospitalization Mortality and rehospitalization were higher at 1-year follow-up(P<0.05,respectively).Compared with super recombination group,patients in obese group were younger,with more female,higher triglyceride,less smokers,more hypertension,diabetes,more edema symptoms on admission and more use of digoxin,as well as the longer length of hospital stay and the higher hospitalization after 1-year follow-up(P<0.05,respectively).Conclusion The long-term prognosis of obese phenotype in elderly patients with HFmrEF was poor.The elderly patients with HFmrEF and obese phenotype have different clinical characteristics from the normal and overweight phenotype,and different prevention strategies may be needed.