老年慢性心力衰竭合并R波递增不良患者心功能、NT-pro-BNP水平及预后研究

Study of cardiac function,NT-proBNP level,and prognosis in elderly patients with chronic heart failure and poor R-wave progression

目的分析老年慢性心力衰竭(CHF)合并R波递增不良(PRWP)患者心功能、血清氨基末端B型脑钠肽前体(NT-pro-BNP)水平及预后情况,为患者的恢复提供临床指导。方法回顾性分析2018年4月至2020年4月江门市新会人民医院收治的100例老年CHF患者的诊疗情况,根据其是否合并PRWP进行分组,其中50例CHF合并PRWP患者为观察组,50例单纯CHF患者为对照组。记录两组患者入院时的心力衰竭分布类型、纽约心脏病学会(NYHA)心功能分级情况以及入院后6 min步行试验分级与距离情况、心脏彩超结果、NT-proBNP水平和终点事件发生情况,采用多因素Logistic回归分析法分析其预后影响因素。结果观察组患者中射血分数降低型心力衰竭(HFrEF)28例,射血分数中间范围型心力衰竭(HFmrEF)12例,射血分数保留型心力衰竭(HFpEF)10例,对照组则分别为16例、15例、19例,两组患者心力衰竭类型分布比较差异有统计学意义(P<0.05);观察组患者的NYHA心功能分级为(3.5±0.5)级,明显高于对照组的(2.8±0.3)级,差异有统计学意义(P<0.05);观察组的6 min步行试验距离为(315.4±76.3)m,明显短于对照组的(351.7±81.2)m,差异有统计学意义(P<0.05);两组患者左心室收缩末期内径(LVESd)、左室舒张功能早晚期充盈的充盈值之比(E/A)、心脏彩超指标值比较,差异均无统计学意义(P>0.05);观察组患者的LVEF水平为(35.8±6.3)%,明显低于对照组的(42.6±7.1)%,LVEDd和NT-proBNP水平分别为(61.4±7.6)mm、(5105.3±2065.7)ng/L,明显高于对照组的(57.3±6.2)mm、(4321.7±1874.8)ng/L,差异均有统计学意义(P<0.05);观察组患者的终点事件总发生率为46.0%,明显高于对照组的22.0%,差异有统计学意义(P<0.05);Logistic回归分析结果显示,PRWP、NT-proBNP、NYHA分级均是老年慢性心力衰竭患者预后不良的独立影响因素(P<0.05),而6 min步行试验距离增加是患者预后不良的保护性因素。结论老年慢性心力衰竭合并R波递增不良患者的NYHA心功能分级和NT-pro-BNP水平偏高,老年CHF合并PRWP通常与心功能不全、左心室扩大、预后不良等因素有关。

Objective To analyze the cardiac function,serum level of N-terminal B-type brain natriuretic peptide(NT-proBNP)and prognosis of elderly patients with chronic heart failure(CHF)combined with poor R-wave progression(PRWP),and provide clinical guidance for the recovery of patients.Methods The diagnosis and treatment of 100 elderly patients with CHF admitted to Xinhui People's Hospital of Jiangmen City from April 2018 to April 2020 were retrospectively analyzed,and the patients were grouped according to whether they were combined with PRWP.Among them,50 patients with CHF combined with PRWP were the observation group and 50 patients with CHF alone were the control group.The distribution types of heart failure at admission,New York Heart Association(NYHA)cardiac function grading,6 min walking test grading and distance after admission,cardiac color ultrasound results,NT-pro BNP level and end-point events were recorded in the two groups to analyze the prognostic factors.Results In the observation group,28 patients had reduced ejection fraction type heart failure(HFrEF),12 patients had intermediate ejection fraction type heart failure(HFmrEF),and 10 patients had retained ejection fraction type heart failure(HFpEF),and corresponding 16 cases,15 cases and 19 cases in the control group.The distribution of heart failure types in the two groups was compared,and the difference was statistically significant(P<0.05);the NYHA cardiac function grade in the observation group was 3.5±0.5,which was significantly higher than 2.8±0.3 in the control group(P<0.05);the 6 min walking distance in the observation group was(315.4±76.3)m,which was significantly shorter than(351.7±81.2)min the control group(P<0.05);there were no statistically significant differences between the two groups in left ventricular end-systolic dimension(LVESD),ratio of filling value(E/A)to early and late filling of left ventricular diastolic function,and cardiac color ultrasound index(all P>0.05);the LVEF level of the observation group was(35.8±6.3)%,which was significantly lower than(42.6±7.1)%of the control group;left ventricular end-diastolic dimension(LVEDD)and NT-proBNP level of observation group were(61.4±7.6)mm and(5105.3±2065.7)ng/L,which were significantly higher than corresponding(57.3±6.2)mm and(4321.7±1874.8)ng/L of the control group(P<0.05);the total incidence of endpoint events in the observation group was 46.0%versus 22.0%in the control group(P<0.05);logistic regression analysis results showed that PRWP,NT-proBNP and NYHA grades were independent influencing factors for poor prognosis in elderly patients with chronic heart failure(P<0.05),and the increase of 6 min walking distance was a protective factor for poor prognosis.Conclusion NYHA cardiac function grade and NT-proBNP level were higher in elderly patients with chronic heart failure complicated with PRWP,and PRWP in elderly CHF patients was usually associated with cardiac dysfunction,left ventricular enlargement,poor prognosis and other factors.