新发心力衰竭与慢性心力衰竭急性加重患者临床预后的相关因素分析

Analysis of related factors of clinical prognosis in patients with new-onset heart failure and acute exacerbation of chronic heart failure

目的本研究旨在分析新发心力衰竭(心衰)和慢性心衰急性加重临床预后的差异,并评估影响其预后的相关因素。方法回顾性分析自2016年9月至2018年5月于山西医科大学附属汾阳医院心血管内科住院的急性心力衰竭(AHF)患者125例,分为新发心衰组和慢性心衰急性加重组,收集两组临床资料并进行随访。终点事件为心衰再住院以及包括心衰再住院和全因死亡的复合终点事件。比较两组患者基线资料,对随访结果作Kaplan-Meier生存分析和Cox回归分析。结果新发心衰组患者47例(37.6%),慢性心衰急性加重组78例(62.4%)。新发心衰组体质指数(BMI)、收缩压、舒张压更高,N末端脑钠肽前体(NT-proBNP)下降幅度更大。中位随访时间12个月,慢性心衰急性加重组复合终点事件发生率和全因死亡率均高于新发心衰组(40.5%vs.19.2%和14.9%vs.6.4%,P<0.05)。KaplanMeier生存分析表明新发心衰组无事件生存率高于慢性心衰急性加重组(P=0.003),而两组间累积生存率差异无统计学意义(P=0.054)。无论是整体还是分组多因素Cox回归分析,出院NT-proBNP都是1年终点事件的危险因素。年龄是慢性心衰急性加重组复合终点事件的危险因素,血尿素氮是新发心衰组复合终点事件的危险因素。结论新发心衰组较慢性心衰急性加重组预后更好,两者的预后均与出院NTproBNP相关。新发心衰和慢性心衰急性加重具有异质性,临床医师应注意区分。

Objective This study aims to analyze the difference in clinical prognosis between new-onset heart failure(heart failure)and acute exacerbation of chronic heart failure,and to evaluate the related factors that affect the prognosis.Methods A retrospective analysis of 125 patients with acute heart failure(AHF)who were hospitalized in the Department of Cardiology,Fenyang Hospital Affiliated to Shanxi Medical University from September 2016 to May 2018 were divided into new heart failure group and chronic heart failure acute Add and reorganize,collect clinical data,and conduct follow-up.Endpoint events were rehospitalization for heart failure and composite endpoint events including rehospitalization for heart failure and all-cause death.The baseline data of the two groups of patients were compared,and Kaplan-Meier survival analysis and Cox regression analysis were performed on the follow-up results.Result There were 47 cases(37.6%)in the new-onset heart failure group and 78 cases(62.4%)in the acute chronic heart failure group.The body mass index(BMI),systolic blood pressure,and diastolic blood pressure of the newly-onset heart failure group were higher,and the N-terminal pro-B-type natriuretic peptide(NT-proBNP)decreased more.With a median follow-up time of 12 months,the incidence of chronic heart failure acute plus recombination composite endpoints and all-cause mortality were higher than those in the new-onset heart failure group(40.5%vs.19.2%and 14.9%vs.6.4%,P<0.05).Kaplan-Meier survival analysis showed that the event-free survival rate of the new-onset heart failure group was higher than that of chronic heart failure acute plus recombination(P=0.003),while the cumulative survival rate difference between the two groups was not statistically significant(P=0.054).Whether it is the overall or group multivariate Cox regression analysis,NT-proBNP is a risk factor for the 1-year endpoint event.Age is a risk factor for the acute and recombined composite endpoint of chronic heart failure,and blood urea nitrogen is a risk factor for the composite endpoint of the new-onset heart failure group.Conclusion The prognosis of the new-onset heart failure group is better than that of chronic heart failure acute plus recombination,and the prognosis of both is related to NT-proBNP when discharged from the hospital.New-onset heart failure and acute exacerbation of chronic heart failure are heterogeneous,and clinicians should pay attention to distinguish.