血清白蛋白水平对慢性心力衰竭心脏再同步化治疗患者预后的预测价值

Predictive Value of Serum Albumin Level in the Prognosis of Patients with Chronic Heart Failure and Cardiac Resynchronization Therapy

目的探讨血清白蛋白水平对慢性心力衰竭心脏再同步化治疗预后的预测价值。方法收集2012年2月~2016年12月在我院心脏中心首次行CRT植入术的合入选标准的189例患者,根据入院时患者血清白蛋白检测结果分为白蛋白正常组和低白蛋白组,比较两组一般资料,并采用单因素和多因素Cox比例风险回归模型分析血清白蛋白水平对心脏再同步化治疗患者全因死亡以及心力衰竭再入院的风险评估作用,另采用Kaplan-Meier生存分析两组患者累计无终点事件的生存率。结果189例慢性心力衰竭接受心脏再同步化治疗患者中白蛋白正常组102例,低蛋白组87例。两组年龄、性别、体重指数、冠心病、高血压、高脂血症、心房颤动、NYHA分级、左心室射血分数、BNP以及肌酐比较,差异均无统计学意义(P>0.05);低蛋白组心脏再同步化治疗术后随访1年、2年、3年总生存率、心力衰竭再入院率低于白蛋白正常组,差异有统计学意义(P<0.05);Cox分析显示,血清白蛋白每下降1 g/L,心脏再同步化治疗患者全因死亡风险增加54.4%(HR=1.544,95%CI:1.156~3.768,P=0.014),而因心力衰竭再入院的风险增加118.9%(HR=2.189,95%CI:1.393~4.459,P=0.027)。结论血清白蛋白水平较低是慢性心力衰竭患者心脏再同步化治疗不良临床预后的独立危险因素,可增加术后3年内全因死亡以及心衰再入院风险,术前血清白蛋白水平对于评估心脏再同步化治疗术后死亡风险具有重要意义。

Objective To explore the predictive value of serum albumin level in the prognosis of chronic heart failure cardiac resynchronization therapy.Methods 189 patients who underwent CRT implantation for the first time in the heart center of our hospital from February 2012 to December 2016 were collected.According to the results of serum albumin test at the time of admission,patients were divided into normal albumin group and low albumin group.The general data of the two groups were compared,and univariate and multivariate Cox proportional hazard regression models were used to analyze the effect of serum albumin levels on the risk assessment of all-cause death and heart failure readmission in patients undergoing cardiac resynchronization therapy.In addition,Kaplan-Meier survival was used to analyze the cumulative survival rate of the two groups of patients without end-point events.Results Among the 189 patients with chronic heart failure who received cardiac resynchronization therapy,there were 102 cases in the normal albumin group and 87 cases in the low protein group.There was no significant difference in age,gender,body mass index,coronary heart disease,hypertension,hyperlipidemia,atrial fibrillation,NYHA classification,left ventricular ejection fraction,BNP and creatinine between the two groups(P>0.05);The 1-year,2-year,and 3-year overall survival rate and re-admission rate of heart failure in the low-protein group after cardiac resynchronization therapy were lower than those in the normal albumin group,the difference was statistically significant(P<0.05);Cox analysis showed that for every 1 g/L decrease in serum albumin,the risk of all-cause death in patients undergoing cardiac resynchronization treatment increased by 54.4%(HR=1.544,95%CI:1.156-3.768,P=0.014).The risk of readmission due to heart failure increased by 118.9%(HR=2.189,95%CI:1.393-4.459,P=0.027).Conclusion Low serum albumin level is an independent risk factor for poor clinical prognosis of patients with chronic heart failure by cardiac resynchronization therapy.It can increase the risk of all-cause death and heart failure readmission within 3 years after surgery.The preoperative serum albumin level is useful for heart assessment.The risk of death after resynchronization therapy is of great significance.