老年营养风险指数及降钙素原在高龄射血分数保留心力衰竭患者预后评估中的价值

Value of the geriatric nutritional risk index and procalcitonin in the evaluation of the prognosis of elderly patients with heart failure preserved ejection fraction

目的探讨老年营养风险指数(GNRI)及降钙素原(PCT)在高龄射血分数保留心力衰竭(HFpEF)患者预后评估中的价值。方法选取2017年1月至2020年1月于海军第九〇五医院住院的高龄(≥80岁)HFpEF患者132例。根据病情的最终转归,分为预后不良组(58例)及预后良好组(74例)。采用Logistic回归分析影响HFpEF患者预后不良的危险因素;采用Spearman相关分析、Pearson相关分析及受试者操作特征(ROC)曲线分析GNRI及PCT对高龄HFpEF患者不良预后的诊断效能。结果单因素分析显示,预后不良组的年龄、GNRI、体重指数(BMI)、合并糖尿病比例、应用利尿剂比例及血清N末端B型利钠肽原(NT⁃proBNP)、血红蛋白(Hb)、降钙素原(PCT)、白蛋白(Alb)指标同预后良好组比较差异均有统计学意义(P<0.05)。Logistic回归分析显示,GNRI及PCT是高龄HFpEF患者预后不良的独立危险因素(P<0.05)。Spearman相关分析显示,GNRI与NT⁃proBNP呈负相关(r=−0.438,P<0.05),PCT与NT⁃proBNP呈正相关(r=0.587,P<0.05)。Pearson相关分析显示,GNRI与PCT呈负相关(r=−0.389,P<0.05)。GNRI、PCT及2项联合检测预测高龄HFpEF患者预后不良的曲线下面积(AUC)分别为0.851、0.927及0.961。结论高龄HFpEF患者常合并存在GNRI下降及PCT升高,GNRI与PCT联合检测可提高对HFpEF患者预后的预测价值。

Objective To explore the value of geriatric nutritional risk index(GNRI)and procalcitonin(PCT)in the evalua⁃tion of the prognosis of elderly patients with heart failure preserved ejection fraction(HFpEF).Methods A total of 132 senior patients(≥80 years old)with stable chronic HFpEF hospitalized in No.905 Naval Hospital from January 2017 to January 2020 were recruited as research subjects.The patients were divided into the poor prognosis group(n=58)and the good prognosis group(n=74),depend⁃ing on their final outcome.Logistic regression was used to analyze risk factors that affected the prognosis of the senior patients with HF⁃pEF.Spearman correlation analysis,Pearson correlation analysis and receiver operating characteristic curve(ROC)were used to ana⁃lyze the diagnostic efficacy of GNRI and PCT in the poor prognosis of the senior patients with HFpEF.Results Univariate analysis showed that there was statistical significance in the age,GNRI,body mass index(BMI),NT⁃proBNP,PCT,albumin(Alb),the pro⁃portion of HFpEF with diabetes,the proportion of diuretic use in the poor prognosis group,as compared with those of the good progno⁃sis group(P<0.05).Logistic regression analysis showed that GNRI and PCT were independent risk factors for poor prognosis in the senior patients with HFpEF(P<0.05).Spearman correlation analysis showed that the GNRI was negatively correlated with the levels of NT⁃proBNP(r=-0.438,P<0.05),while PCT was positively correlated with the levels of NT⁃proBNP(r=0.587,P<0.05).Pear⁃son correlation analysis indicated that the GNRI was negatively correlated with the levels of PCT(r=-0.389,P<0.05).The areas un⁃der the curve(AUC)for the GNRI,PCT and the two combined tests in the prediction of poor prognosis of elderly patients with HFpEF were 0.851,0.927 and 0.961.Conclusion Decreased GNRI and Increased PCT frequently coexisted in senior patients with HF⁃pEF.The combined detection of GNRI and PCT is of good value in predicting poor prognosis of senior patients with HFpEF.