β受体阻滞剂对老年慢性心力衰竭合并慢性阻塞性肺病患者死亡风险的影响

Effect of beta-adrenergic receptor blockers on the risk of death in elderly patients with chronic heart failure and chronic obstructive pulmonary disease

目的分析β受体阻滞剂对老年轻中度慢性心力衰竭(心衰)合并慢性阻塞性肺病(COPD)患者全因死亡的影响,并分析影响死亡风险的相关因素。方法多中心回顾性队列研究,连续性纳入2013年1月至2017年12月在日照市人民医院(187例)、山东省立医院(122例)和北京安贞医院(91例)诊治的老年心衰合并COPD患者.其中应用β受体阻滞剂患者(β受体阻滞剂组)200例,依据倾向评分匹配法按照1:1比例选择年龄和心肺功能匹配、未应用β受体阻滞剂的200例老年患者为对照组,随访截至2019年12月31日.比较两组患者死亡风险.分析影响全因死亡风险的相关因素。结果400例患者中,年龄(72.2±11.7)岁.男性226例(56.5%).匹配后两组患者年龄、男性比例、体质指数、心功能、肺功能和治疗等基线资料差异无统计学意义(均P>0.05)。随访3年时,β受体阻滞剂组较对照组全因死亡风险(χ^(2)=7.284.P<0.01)、因心衰加重住院风险(χ^(2)=6.782.P<0.01)和因COPD急性加重而住院风险(χ^(2)=6.921.P<0.01)均降低。多因素Cox回归分析结果显示。年龄≥75岁(HR=2.142)、糖尿病(HR=1.929).基线第1秒呼出量/用力肺活量(FEV1/FVC)<66.8%(HR=1.114).基线肾小球滤过率<72.0 ml/min(HR=3.572)和随访3年时左心室射血分数<46.4%(HR=2.294)是影响全因死亡风险的危险因素,而β受体阻滞剂(HR=0.745)是全因死亡的保护因素(均P<0.05)。结论β受体阻滞剂可降低老年心衰合并COPD患者的死亡风险和再住院风险。

Objective To analyze the effects ofβ-receptor blockers on all cause mortality in elderly patients with mild-moderate chronic heart failure(CHF)and chronic obstructive pulmonary disease(COPD),and to analyze risk factors relevant to death.Methods.This was a multicenter retrospective cohort study from January 2013 to December 2017.The 400 elderly patients with CHF and COPD treated in Rizhao People's Hospital(187 cases).Shandong Provincial Hospital(122 cases)and Bejing Anzhen Hospital(91 cases)were enrolled.The patients receiving β-receptor blockers were included as β-receptor blockers group(n=200),and the patients matching for similar age and cardio-pulmonary function,not receiving β-receptor blockers were selected as the control group(n=200).All patients were followed up until December 31,2019.The primary endpoints were all-cause mortality.The risk factors for all cause death were compared and analyzed.Results Among 400 patients.the average age was(72.2±11.7)years with 226 males(56.5%)。There was no significant difference in baseline data such as age.gender ratio,body mass index.heart function.lung function,and treatment regimen after matching between the 1two groupsall (P>0.05).At end of 3-years follow-up,risks of all cause mortality(χ^(2)=7.284.P<0.01).and re hospitalization risk due to worsening heart failure(χ^(2)=6.782.P<0.01).acute exacerbation of COPD(χ^(2)=6.921.P<0.01)were significantly reduced inβ-receptor blockers group versus control group.Mulivariate Cox regression analysis showed that age≥75 years(HR=2.142).diabetes(HR=1.929).ratio of baseline forced expiratory volume in the first second/forced vital capacity<66.8%(HR=1.114).baseline glomerular filtration rate<72.0 ml/min(HR=3.572)and left ventricular ejection fraction<46.4%(HR=2.294)at end of 3-year follow-up were risk factors for mortality.while3 receptor blockers(HR=0.745)was a protective factor(all P<0.05).Conclusions β-receptor blockers can significantly reduce the mortality and re hospitalization rate in elderly patients with CHF and COPD.