新发心力衰竭与慢性心力衰竭急性加重临床预后差异及影响因素分析

Differences in clinical prognosis between new-onset heart failure and acute exacerbation of chronic heart failure and its influencing factors

目的探讨新发心力衰竭(HF)与慢性心力衰竭(CHF)急性加重患者临床预后差异并分析临床预后影响因素,旨在为临床诊治工作提供更多借鉴。方法回顾性纳入2020年1月至2022年1月于周口市中心医院诊治急性HF患者共138例,包括新发HF患者55例和CHF急性加重患者83例,分别设为新发组和急性加重组;比较两组临床特征资料及终点事件发生情况,采用单因素和多因素法评估新发HF与CHF急性加重患者临床预后独立影响因素。结果新发组体重指数、收缩压水平、舒张压水平、合并吸烟比例、血清钠水平及住院期间N末端脑钠肽前体(NT-proBNP)下降水平均显著高于急性加重组(P<0.05)。急性加重组随访12个月复合终点事件发生率和全因死亡率均显著高于新发组(P<0.05);急性加重组随访12个月无事件生存率均显著低于新发组(P<0.05);两组随访12个月累积生存率比较差异无统计学意义(P>0.05)。多因素Cox回归模型分析结果显示,血BNP水平和出院时NT-proBNP水平是新发HF患者随访复合终点事件发生独立影响因素(P<0.05);年龄和出院时NT-proBNP水平是CHF急性加重患者随访复合终点事件发生独立影响因素(P<0.05)。结论与新发HF相比,CHF急性加重患者临床预后更差;而在预后影响因素方面两类患者均与出院时NT-proBNP水平独立相关。

【Objective】To investigate the difference in clinical prognosis of patients with new-onset heart failure(HF)and acute exacerbation of chronic heart failure(CHF)and analyze the influencing factors of clinical prognosis,so as to provide more reference for clinical diagnosis and treatment.【Methods】A total of 138 patients with acute HF were treated in our hospital from January 2020 to January 2022,including 55 patients with new-onset HF and 83 patients with acute exacerbation of CHF,who were considered as new-onset group and acute exacerbation group,respectively.The clinical characteristics and endpoint event occurrence between the two groups were compared,and univariate and multivariate methods were used to evaluate independent prognostic factors in patients with new-onset HF and acute exacerbation of CHF.【Results】In the new-onset group,physical index,systolic blood pressure level,diastolic blood pressure level,proportion of smoking,serum sodium level and the decrease of N-terminal brain natridium peptide precursor(NT-proBNP)were significantly higher than those of acute exacerbation group(P<0.05).The 12-month composite endpoint event occurrence rate and all-cause mortality of the acute exacerbation group were significantly higher than those of the new-onset group(P<0.05);the 12-month event-free survival rate of the acute exacerbation group was significantly lower than that of the new-onset group(P<0.05);there was no statistically significant difference in the cumulative survival rate between the two groups after 12 months of follow-up(P>0.05).The results of multivariate Cox regression model analysis showed that blood BNP level and NT-proBNP level at discharge were independent influencing factors for the occurrence of composite endpoint events in patients with new-onset HF during follow-up(P<0.05);age and NT-proBNP level at discharge were independent influencing factors for the occurrence of composite endpoint events in patients with acute exacerbation of CHF during follow-up(P<0.05).【Conclusion】Patients with acute exacerbation of CHF had worse clinical outcomes compared with new-onset HF;both categories were independently associated with NT-proBNP levels at discharge.