老年慢性阻塞性肺疾病患者并发心力衰竭的影响因素

Influencing Factors of Heart Failure in Elderly Patients with Chronic Obstructive Pulmonary Disease

目的探讨老年慢性阻塞性肺疾病(COPD)患者并发心力衰竭的危险因素。方法回顾性分析2019年1月至2020年1月铜陵市第四人民医院呼吸内科收治的107例老年COPD患者的临床资料,根据是否并发心力衰竭分为COPD并发心力衰竭组(45例)和COPD无心力衰竭组(62例)。比较两组患者的一般资料及血清同型半胱氨酸(Hcy)、脑钠肽(BNP)及高敏C反应蛋白(hs-CRP)水平,分析COPD患者并发心力衰竭的危险因素。结果COPD并发心力衰竭组患者年龄大于COPD无心力衰竭组(P<0.01),COPD病程长于COPD无心力衰竭组(P<0.01),左心室射血分数小于COPD无心力衰竭组(P<0.01),两组肺功能分级、美国纽约心脏病协会(NYHA)分级比较差异有统计学意义(P<0.05)。COPD并发心力衰竭组患者血清Hcy、BNP及hs-CRP水平均明显高于COPD无心力衰竭组[(27.0±3.4)μmol/L比(22.8±2.9)μmol/L,(679±82)ng/L比(497±62)ng/L,(30±4)mg/L比(18±3)mg/L](均P<0.01)。多因素Logistic回归分析结果显示,COPD病程、左心室射血分数、NYHA分级、Hcy、BNP及hs-CRP为COPD患者并发心力衰竭的独立危险因素(OR=1.373,95%CI 1.218~2.246;OR=1.964,95%CI 1.537~3.185;OR=2.061,95%CI 1.172~3.620;OR=2.620,95%CI 1.412~4.860;OR=2.083,95%CI 1.125~2.824;OR=2.759,95%CI 1.413~4.860)(P<0.05或P<0.01)。结论COPD病程、左心室射血分数、NYHA分级、Hcy、BNP以及hs-CRP是老年COPD患者并发心力衰竭的高危因素,临床需加强对该类患者的重视,进而给予相应干预措施,降低心力衰竭发生风险。

Objective To investigate?the risk factors of heart failure in elderly patients with chronic obstructive pulmonary disease(COPD).Methods The clinical data of 107 elderly COPD patients admitted to the Department of Respiratory Medicine,the Fourth People′s Hospital of Tongling City from Jan.2019 to Jan.2020 were retrospectively analyzed.According to the occurrence of heart failure,they were divided into a COPD with heart failure group(45 cases)and a COPD without heart failure group(62 cases).The general data,serum homocysteine(Hcy),brain natriuretic peptide(BNP)and high-sensitivity C-reactive protein(hs-CRP)levels of the two groups were compared,and the risk factors of COPD patients complicated with heart failure were analyzed.Results The age of patients in the COPD with heart failure group was larger than that in the COPD without heart failure group(P<0.01),the course of COPD was longer than that in the COPD without heart failure group(P<0.01),and the left ventricular ejection fraction was lower than that in the COPD without heart failure group(P<0.01).There were statistically significant differences in lung function grading and New York Heart Association(NYHA)grading between the two groups (P<0.05).Serum Hcy,BNP and hs-CRP levels in the COPD with heart failure group were significantly higher than those in the COPD patients without heart failure group[(27.0±3.4)μmol/L vs(22.8±2.9)μmol/L,(679±82)ng/L vs(497±62)ng/L,(30±4)mg/L vs(18±3)mg/L](all P<0.01).Multivariate Logistic regression analysis showed that the course of COPD,left ventricular ejection fraction,NYHA grade,Hcy,BNP and hs-CRP were independent risk factors for heart failure in COPD patients(OR=1.373,95%CI 1.218-2.246;OR=1.964,95%CI 1.537-3.185;OR=2.061,95%CI 1.172-3.620;OR=2.620,95%CI 1.412-4.860;OR=2.083,95%CI 1.125-2.824;OR=2.759,95%CI 1.413-4.860)(P<0.05 or P<0.01).Conclusion COPD duration,left ventricular ejection fraction,NYHA grade,Hcy,BNP and hs-CRP are the risk factors for heart failure in elderly patients with COPD.Clinical attention should be paid to these patients,and corresponding interventions should be given,to reduce the risk of heart failure.