心脏结构及营养状态与老年慢性心力衰竭预后的关系

Relationship between Cardiac Structure and Nutritional Status and Prognosis in Elderly Patients with Chronic Heart Failure

目的:探讨心脏结构及营养状态与老年慢性心力衰竭预后的关系。方法:选取2016年9月—2021年9月成都市第三人民医院收治的老年慢性心力衰竭病人101例作为病例组,美国纽约心脏病协会(NYHA)心功能Ⅱ级34例,Ⅲ级40例,Ⅳ级27例。另选取2016年9月—2021年9月成都市第三人民医院的健康体检者60名作为对照组。采用化学发光法测定肌钙蛋白I(cTnI)和N末端B型钠尿肽前体(NT-proBNP)水平;采用心脏超声心动图测定左心室射血分数(LVEF)和左心室舒张末期内径(LVEDD);采用老年人营养风险指数(GNRI)评估病人营养状态。结果:病例组血清cTnI、NT-proBNP水平高于对照组,LVEF低于对照组,而LVEDD高于对照组,差异均有统计学意义(P<0.05)。病例组GNRI低于对照组(P<0.05)。心功能Ⅳ级病人血清cTnI、NT-proBNP水平及LVEDD高于心功能Ⅲ级和Ⅱ级病人,且心功能Ⅲ级病人血清cTnI、NT-proBNP水平及LVEDD高于心功能Ⅱ级病人,差异均有统计学意义(P<0.05);心功能Ⅳ级病人LVEF、GNRI低于心功能Ⅲ级和Ⅱ级病人,且心功能Ⅲ级病人LVEF、GNRI低于心功能Ⅱ级病人,差异均有统计学意义(P<0.05)。预后不良病人血清cTnI和NT-proBNP水平高于预后良好病人,LVEF低于预后良好病人,而LVEDD高于预后良好病人,差异均有统计学意义(P<0.05)。预后不良病人GNRI低于预后良好病人(P<0.05)。GNRI与LVEF呈正相关(P<0.05),而与LVEDD、cTnI和NT-proBNP呈负相关(P<0.05)。结论:老年慢性心力衰竭病人血清cTnI和NT-proBNP水平升高,GNRI下降,并与心功能分级和预后密切相关。

Objective:To investigate the relationship between cardiac structure and nutritional status and prognosis of elderly patients with chronic heart failure.Methods:A total of 101 elderly patients with chronic heart failure in The Third People's Hospital of Chengdu from September 2016 to September 2021 were selected as case group.New York Heart Association(NYHA)cardiac function classification:34 cases with grade Ⅱ,40 cases with grade Ⅲ,and 27 cases with grade Ⅳ.Another 60 healthy people who underwent physical examination in The Third People's Hospital of Chengdu from September 2016 to September 2021 were selected as control group.Chemiluminescence assay was used to measure troponin I(cTnI)and N-terminal precursor B-type natriuretic peptide(NT-proBNP).Cardiac echocardiography was used to measure left ventricular ejection fraction(LVEF)and left ventricular end-diastolic dimension(LVEDD).The nutritional status of patients was assessed using the Geriatric Nutritional Risk Index(GNRI).Results:The serum levels of cTnI and NT-proBNP in case group were higher than those in control group,LVEF was lower than that in control group,and LVEDD was higher than that in control group,the differences were statistically significant(P<0.05).GNRI of case group was lower than that of control group(P<0.05).The levels of cTnI,NT-proBNP,and LVEDD of patients with cardiac function gradeⅣwere higher than those of patients with grade Ⅲ and grade Ⅱ,and the levels of cTnI,NT-proBNP,and LVEDD of patients with cardiac function grade Ⅲ were higher than those of patients with grade Ⅱ,the differences were statistically significant(P<0.05).LVEF and GNRI of patients with cardiac function grade Ⅳ were lower than those of patients with grade Ⅲ and grade Ⅱ,and LVEF and GNRI of patients with cardiac function grade Ⅲ were lower than those of patients with grade Ⅱ,the differences were statistically significant(P<0.05).The serum levels of cTnI and NT-proBNP in patients with poor prognosis were higher than those in patients with good prognosis,LVEF was lower than that in patients with good prognosis,and LVEDD was higher than that in patients with good prognosis,the differences were statistically significant(P<0.05).GNRI of patients with poor prognosis was lower than that of patients with good prognosis(P<0.05).GNRI was positively correlated with LVEF(P<0.05),but negatively correlated with LVEDD,cTnI,and NT-proBNP(P<0.05).Conclusion:Serum levels of cTnI and NT-proBNP are increased and GNRI is decreased in elderly patients with chronic heart failure,which is closely related to cardiac function classification and prognosis.