老年人射血分数保留的心力衰竭临床特征分析

Analysis of Clinical Features of Heart Failure in Elderly with Ejection Fraction Retention

目的分析老年人射血分数保留的心力衰竭患者临床特征,探究其病理生理机制,进而指导老年人射血分数保留心衰的治疗。方法方便选取2018年12月-2019年7月入住该院心血管内科的老年心力衰竭患者,NYHAⅡ~Ⅳ级伴有明确心脏疾病史且符合2008年ESC心衰诊断标准的病例,按照射血分数分为射血分数保留HFpEF (EF≥50%)组,射血分数中间值HFmrEF(EF 40%~49%)组,射血分数降低HFrEF(EF<40%)组;分析3组心衰患者各项指标特征。结果共入选260例老年心衰患者,射血分数保留(HFpEF)组140例,射血分数中间值(HFmrEF)组30例,射血分数降低(HFrEF)组90例。HFpEF组中患者平均收缩压(135±12)mmHg高于HFrEF组(120±10)mmHg及HFmrEF组(125±8)mmHg,差异有统计学意义(P<0.05);HFpEF组中患者尿酸水平(505±45.5)μmol/L高于HFrEF组(425±40.5)μmol/L及HFmrEF组(420±42.5)μmol/L,差异有统计学意义(P<0.05);HFpEF组中患者合并糖尿病比例(28.6%)高于HFrEF组(21.1%)及HFmrEF组(20.0%),差异有统计学意义(P<0.05);HFpEF组中女性患者(51.4%)略多于HFrEF组(48.9%)及HFmrEF组(46.7%),差异无统计学意义(P>0.05)。结论该分析提示老年人射血分数保留的心力衰竭患者中收缩压、尿酸水平偏高,合并糖尿病患者比例多,提示两者生理病理机制有所不同,有助于为射血分数保留的心力衰竭患者管理策略的制定和进一步治疗提供有利方向。

Objective To analyze the clinical characteristics of heart failure patients with ejection fraction retention in the elderly,to explore their pathophysiology,and to guide the treatment of heart failure in elderly patients with ejection fraction retention.Methods Select conveniently elderly patients with heart failure who were admitted to the Department of Cardiovascular Medicine of the hospital from December 2018 to July 2019.NYHAⅡ-Ⅳcases with a clear history of heart disease and meeting the 2008 ESC diagnostic criteria for heart failure,according to ejection fraction Divided into:ejection fraction retention HFpEF(EF≥50%)group,median ejection fraction HFmrEF(EF 40%-49%)group,ejection fraction reduction HFrEF(EF<40%)group;Analyze the characteristics of various indicators in three groups of patients with heart failure.Results A total of 260 elderly patients with heart failure were enrolled,140 in the HFpEF group,30 in the HFmrEF group,and 90 in the HFrEF group.The mean systolic blood pressure(135±12)mmHg in the HFpEF group was higher than that in the HFrEF group(120±10)mmHg and the HFmrEF group(125±8)mmHg,the difference was statistically significant(P<0.05);the uric acid level in the HFpEF group was(505±45.5)μmol/L was higher than that in the HFrEF group(425±40.5)μmol/L and the HFmrEF group(420±42.5)μmol/L,the difference was statistically significant(P<0.05);the proportion of patients with diabetes in the HFpEF group(28.6%)was higher In the HFrEF group(21.1%)and the HFmrEF group(20.0%),and the difference was statistically significant(P<0.05);female patients(51.4%)in the HFpEF group were slightly more than the HFrEF group(48.9%)and the HFmrEF group(46.7%),the difference was not statistically significant(P>0.05).Conclusion This analysis suggests that elderly patients with heart failure who have ejection fraction retention have higher systolic blood pressure and uric acid levels,and a higher proportion of patients with diabetes,suggesting that the physiological and pathological mechanisms of the two are different, which helps to retain the ejection fraction development of further strategies for the management of patients with failure and further treatment provide favorable directions.