红细胞压积对射血分数保留型及射血分数中间型心力衰竭患者易损期的影响

Influence of hematocrit on the vulnerable phase in patients with HFpEF and HFmrEF

目的探讨红细胞压积(hematocrit,HCT)对射血分数保留型及射血分数中间型心力衰竭(HFpEF和HFmrEF)患者易损期的影响.方法选取2017年5月1日至2018年5月31日于我院确诊为射血分数保留及射血分数中间型(EF≥40%)且根据纽约心脏病协会心功能分级为Ⅱ级及以上的心力衰竭患者行前瞻性队列研究,共纳入心力衰竭患者175例,失访15例,最终纳入160例.选取同一时间住院的180例非心力衰竭患者作为对照.通过单因素Logistic相关分析确定HCT、年龄、糖尿病、左心室射血分数、血红蛋白、脑钠肽、白蛋白、肌酐、尿酸是患者发生心力衰竭的危险因素.通过单因素Cox回归分析研究HCT对HFpEF和HFmrEF患者易损期的影响.结果随访3个月,低HCT组心力衰竭患者终点事件发生率高(HR=0.488,95%CI0.258~0.926,P=0.028),具有统计学意义.Kaplan-Meier生存曲线显示低HCT组不良心血管事件发生率更高,生存率低(P=0.025),预后不佳,具有统计学意义,尤其是心力衰竭加重再入院(P=0.006).结论低HCT可能是HFpEF and HFmrEF患者易损期不良预后的危险因素.

Objective To investigate the influence of hematocrit on the vulnerable phase in patients with HFpEF and HFmrEF. Methods 160 patients in our hospital from May 1, 2017 to May 31, 2018 diagnosed as HFpEF and HFmrEF(EFM0%, New York Heart Association Ⅱ-Ⅳ)were enrolled and went prospective cohort study. 180 patients were selected without heart failure AS control. HCT, age, diabetes mellitus, LVEF, hemoglobin, BNP, albumin, creatinine, uric acid is a risk factor for heart failure patients by single factor Logistic related analysis. Univariate Cox regressions were uesd to analyze the influence of HCT on the patienfs prognosis. Results The follow-up time was 3 months, compared with high HCT group, the rates of end events in low HCT group were higher (HR=0.488, 95% CI 0.258-0.926, P=0.028) and were of statistical significance. The Kaplan- Meier survival curve showed low HCT group had the higher incidences of major adverse cardiac events and lower survival rate (P=0.025) especially going hospital for the development of HF symptoms (P=0.006). Conclusion Low HCT may be a risk factor for poor prognosis in patients with HFpEF and HFmrEF on the vulnerable phase.