贫血对慢性心力衰竭住院患者预后影响的回顾性分析

Retrospective analysis of anemia on prognosis influence of hospitalized chronic heart failure patients

目的回顾性分析贫血对慢性心力衰竭住院患者预后的影响。方法收集天津医科大学第二医院心脏科1980-01至2007-08 CHF住院患者,根据血红蛋白(hemoglobin,Hb)水平将CHF患者分为贫血组(A组)和非贫血组(B组),分析合并贫血的CHF患者临床特点、治疗情况,应用Logistic回归法进行预后影响因素分析。结果共入选CHF患者2459例,A组538例(21.9%),B组1921例(78.1%)。A组患者年龄较大,心功能较差,且住院全因病死率较高(χ2=32.846,P<0.01),A组患者中应用ACEI、ARB、β-受体阻滞剂、他汀类药物的患者较未应用的患者病死率低(9.8%vs 16.8%P<0.05,6.2%vs 15.2%P<0.05,2.2%vs 13.4%P<0.01,2.9%vs 15.8%P<0.01)。使用多变量分析校正其它危险因素后,贫血是增加CHF住院患者病死率的独立危险因素,入院时血红蛋白每下降10g/L,病死率增加12.7%(χ2=5.509,P<0.05)。结论CHF患者合并贫血的发生率较高,且住院病死率较高,贫血是增加CHF患者住院病死率的独立危险因素,ACEI、ARB、β-受体阻滞剂、他汀类药物的应用对于改善患者的预后可能具有重要意义。

Objective To analyze prognosis influence of anemia on hospitalized chronic heart failure(CHF)patients retrospectively.Methods All data were collected from the Second Hospital of Tianjin Medical University from January 1980 to August 2007.According to hemoglobin(Hb),we divided all CHF patients into two groups:group A(the anemia group),group B(the nonanemia group).Clinical characteristics and therapeutic conditions were analyzed and compared between the two groups.The prognostic influence factor was analyzed by Logistic regression.Results 2459 CHF cases were enrolled,among which 538 patients(21.9%)had anemia.The patients in group A were elder,with worse cardiac function than patients in group B.And the patients in group A had higher rate of hospitalized case-fatality rate than patients in group B(χ^2=32.846,P<0.01).The rate of hospitalized case-fatality in patients of group A who used ACEI,ARB,BB and statins was lower than who didn’t use the drugs(9.8%vs 16.8%P<0.05,6.2%vs 15.2%P<0.05,2.2%vs 13.4%P<0.01,2.9%v s 15.8%P<0.01).The hospitalized case-fatality rate was higher in group A than group B(P<0.01).After corrected other risk factors by multivariate logistic regression,anemia was an independent risk factor for hospitalized case-fatality rate.The rate of hospitalized case-fatality increased by 12.7%for every 10 g/L decrease in HB admission leve1(χ^2=5.509,P<0.05).Conclusions Patients with CHF have a higher incidence of anemia and a higher hospital mortality rate.Anemia is an independent risk factor for increasing hospital mortality in patients with CHF.The use of ACEI,ARB,BB and statins may improve the prognosis of CHF patients.