射血分数保留的老年心力衰竭患者的临床特征

Clinical Feature of Elderly Heart Failure Patients with Ejection Fraction Retention

目的:分析和比较射血分数保留的心力衰竭(HFp EF)、射血分数中间值(HFmr EF)及射血分数降低的老年心力衰竭(HFr EF)患者临床特征的差异。方法:选取2017年9月至2018年8月哈尔滨市第一医院收治的老年慢性心力衰竭患者共287例,根据心动超声所测左室舒张末期内径(LVEF)值将其分为3组:HFpEF组175例、HFmr EF组50例和HFr EF组62例。比较各组患者一般情况、心动超声检查结果、血清学指标的差异。结果:(1)与HFr EF组患者比较,HFpEF组患者年龄、性别、吸烟史、体重指数(BMI)、原发冠心病、高血压、2型糖尿病患者比例、房颤发生率及心功能分级构成比均具有统计学差异(P<0.05);(2)与HFr EF组相比较,HFpEF组患者的E/A比值,左房内径、肺动脉内径、LVEDD较小,而室间隔厚度较厚(P<0.05);(3)与HFr EF组患者相比,HFpEF组血清总胆固醇、甘油三酯较高;血肌酐、血尿素氮、血尿酸、超敏C反应蛋白、N-末端脑钠肽前体水平较低,具有统计学差异(P<0.05)。结论:老年HFpEF心力衰竭患者以女性居多,体重指数较大,以向心性肥胖为主,血压水平较高,心功能II级者比例高,有明显的舒张功能不全,易发生房性心律失常,房颤发生率高,主要病因为高血压。

Objective: To investigate and compare the clinical characteristics of heart failure with retained ejection fraction(HFpEF), heart failure with intermediate ejection fraction(HFmr EF) and heart failure with reduced ejection fraction(HFr EF) in the elderly patients. Methods: A total of 287 elderly patients with chronic heart failure admitted to the Harbin first hospital from September 2017 to August 2018 were selected. According to the LVEF value measured by echocardiography, they were divided into 3 groups: 175 patients in the HFpEF group;There were 50 cases in HFmr EF group and 62 cases in HFr EF group. The general situation, cardiac ultrasound,serology and other indicators of patients in each group were compared, and the clinical characteristics of the three groups were analyzed and compared. Results:(1)Compared with patients in the HFr EF group, the age, gender, smoking history, body mass index(BMI) proportion of patients in the HFp EF group, the proportion of coronary heart disease, hypertension, type 2 diabetes among the primary causes, the incidence rate of atrial fibrillation and the composition ratio of cardiac function classification were statistically different(P<0.05);(2)Compared with the HFr EF group, the E/A ratio of patients in the HFp EF group showed smaller left atrial diameter, pulmonary artery diameter and LVEDD, while thicker ventricular septal thickness(P<0.05).(3) Compared with patients in the HFr EF group, serum total cholesterol and triglyceride in the HFpEF group were higher;Serum creatinine, blood urea nitrogen, blood uric acid, hypersensitive c-reactive protein and n-terminal brain natriuretic peptide precursor levels were lower, with statistically significant differences(P<0.05). Conclusion: Among the elderly patients with heart failure, the majority of HFp EF patients are women. The body mass index(BMI) was large,and the centripetal obesity was the main one. High blood pressure. The main disease is hypertension, and the incidence of atrial fibrillation is high. In terms of cardiac function evaluation, patients in the HFp EF group have more level II cardiac function and are prone to atrial arrhythmia. There is obvious diastolic insufficiency.