血清胆红素水平对老年慢性心力衰竭患者全因死亡风险的预测作用

Predictive effect of serum bilirubin levels for the risk of all-cause mortality in elderly patients with chronic heart failure

目的探讨胆红素系统与老年慢性心力衰竭(chronic heart failure,CHF)患者全因死亡风险的关系。方法选取2016年3月至2017年3月诊治住院的老年CHF患者216例为观察组,同期健康体检者为对照组,检测2组血清直接胆红素(direct bilirubin,DBiL)、间接胆红素(indirect bilirubin,IBiL)、总胆红素(total bilirubin,TBiL)及心功能、肾功能、肝功能及血脂水平,Pearson法分析血清DBiL、IBiL、TBiL与各指标的相关性。患者出院后随访2年,比较不同血清DBiL、IBiL、TBiL患者的生存率,多因素Cox回归分析CHF患者预后的影响因素。结果观察组血清DBiL、IBiL、TBiL、氨基末端B型脑利钠肽前体(N-terminal proBNP,NT-proBNP)均较对照组增高(P<0.05),左心室舒张末期内径(left ventricular end-diastolic dimension,LVEDd)较对照组增大(P<0.05),左心室射血分数(left ventricular ejection fractions,LVEF)较对照组降低(P<0.05);216例CHF患者随访2年死亡52例,生存164例,其中血清DBiL<4.50μmol/L、IBiL<17.80μmol/L、TBiL<23.70μmol/L患者生存率(81.48%、80.00%、80.36%)高于DBiL≥4.50μmol/L、IBiL≥17.80μmol/L、TBiL≥23.70μmol/L患者(59.26%、60.78%、60.42%)(P<0.05);DBiL、IBiL、TBiL均与LVEF呈负相关,与NT-proBNP、UA呈正相关(P<0.05);多因素Cox回归分析显示,在调整年龄、性别等因素后,TBiL≥23.70μmol/L是CHF患者预后不良的危险因素(HR=1.71,95%CI:1.56~1.93,P=0.006)。结论老年CHF患者血清DBiL、IBiL、TBiL均升高,TBiL水平升高增加患者远期全因死亡风险。

Objective To investigate the correlation between bilirubin system and all-cause mortality risk in elderly patients with chronic heart failure(CHF).Methods A total of 216 elderly patients with CHF who were admitted and treated in our hospital from March 2016 to March 2017 were enrolled as observation group,at the same time,the healthy subjects who underwent physical examination were enrolled as control group.The serum levels of direct bilirubin(DBiL),indirect bilirubin(IBiL)and total bilirubin(TBiL)were detected,moreover,the cardiac function,renal function,liver function and blood lipid levels were observed and compared between the two groups.Pearson’s method was used to analyze the correlation between serum DBiL,IBiL,TBiL and the other indexes.In addition the patients were followed up for 2 years after discharging from hospital,and the survival rates of patients with different serum levels of DBiL,IBiL,and TBiL were observed and compared.Multivariate Cox regression analysis was used to analyze the influencing factors on the prognosis of patients with CHF.Results The serum levels of DBiL,IBiL,TBiL,and N-terminal proBNP(NT-proBNP)in observation group were significantly higher than those in control group(P<0.05).The left ventricular end-diastolic diameter(LVEDd)was significantly increased in observation group,as compared with that in control group(P<0.05),however,the left ventricular ejection fraction(LVEF)in observation group were significantly decreased,as compared with that in control group(P<0.05).The 216 patients with CHF were followed up for 2 years,of whom,52 patients died and 164 patients survived.Moreover the survival rates of patients with serum levels of DBiL<4.50μmol/L,IBiL<17.80μmol/L,and TBiL<23.70μmol/L(81.48%,80.00%,80.36%)were significantly higher than those of patients with serum levels of DBiL≥4.50μmol/L,IBiL≥17.80μmol/L and TBiL≥23.70μmol/L(59.26%,60.78%,60.42%)(P<0.05).In addition DBiL,IBiL and TBiL were negatively correlated with LVEF,however,which were positively correlated with NT-proBNP and UA(P<0.05).Multivariate Cox regression analysis showed that after adjusting age,gender and other factors,TBiL≥23.70μmol/L was a risk factor for poor prognosis of patients with CHF(P<0.01).Conclusion The serum levels of DBiL,IBiL and TBiL are increased in elderly patients with CHF,and the increasing of TBiL levels may increase the risk of long-term all-cause mortality in patients with CHF.