老年高血压患者的全身炎症指数与心力衰竭的相关性及护理指导:基于美国国家健康和营养调查数据库的数据分析

Correlation between systemic immune-inflammation index and heart failure in elderly patients with hypertension and nursing guidance:an data analysis based on National Health and Nutrition Examination Survey

目的探讨老年高血压人群中全身免疫炎症指数(SII)与心力衰竭患病率的相关性以及对护理工作的启示。方法从1999—2010年美国国家健康和营养调查(NHANES)数据库筛选5607例60岁及以上高血压患者为研究对象,分为心力衰竭组(437例)和非心力衰竭组(5170例)。将所有参与者根据SII水平的不同按照四分位法分为Q_1~Q_4组,Q_1组为参照组。逐步调整潜在混杂因素,通过Logistic回归分析探讨4组心力衰竭患病率的差异,并进行亚组分析。结果2组患者在种族、年龄、教育水平、收入水平、吸烟史、饮酒史、体质量指数(BMI)、C反应蛋白、估算肾小球滤过率(eGFR)、血红蛋白、糖尿病史和冠心病史等方面比较,差异有统计学意义(P<0.05)。与非心力衰竭组相比,心力衰竭组淋巴细胞计数和血小板计数较低,而中性粒细胞计数和SII较高,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果表明,SII升高与心力衰竭患病率呈正相关(P<0.05)。在调整相关混杂因素后,SII第2至第4分位数的患者心力衰竭患病率的比值比(OR)和95%置信区间(95%CI)分别为0.80(0.57~1.11)、1.14(0.84~1.56)和1.38(1.02~1.87)(趋势P=0.006)。根据性别、糖尿病、冠心病、高脂血症和eGFR进行亚组分析,结果表明,在没有冠心病、eGFR≤90 mL/(min·1.73m~2)、无论有无高脂血症的女性中,SII最高四分位数(Q_4)的参与者较Q_1罹患心力衰竭的风险更高(趋势P<0.05)。结论SII可能与老年高血压人群心力衰竭患病率独立相关,对临床及护理工作具有指导意义。

Objective To explore the relationship of the systemic immune-inflammation index(SII)with heart failure incidence in elderly people with hypertension and its nursing implications.Methods According to the data of the National Health and Nutrition Examination Survey(NHANES)database from 1999 to 2010,a total of 5607 hypertension patients aged 60 and above were screened out and divided into heart failure group with 437 cases and non-heart failure group with 5170 cases.All the participants were divided into Q 1 to Q 4 groups based on their SII levels by using the quartile method,with Q 1 as the reference group.After gradually adjusting for potential confounding factors,the differences in prevalence rate of heart failure among four groups were explored by Logistic regression analysis,and subgroup analyses were conducted as well.Results There were significant differences in race,age,education level,income level,smoking history,drinking history,body mass index(BMI),C-reactive protein,estimated glomerular filtration rate(eGFR),hemoglobin,diabetes history and coronary heart disease history between the two groups(P<0.05).Compared with the non-heart failure group,the heart failure group had significant lower lymphocyte and platelet counts,while the neutrophil count and SII were significantly higher(P<0.05).The result of multiple Logistic regression analysis showed a positive correlation between the increase of SII and the prevalence rate of heart failure(P<0.05).After adjusting for related confounding factors,the values of odds ratio(OR)and 95%confidence interval(95%CI)for prevalence rate of heart failure in patients with SII from the second to the fourth quartiles were 0.80(0.57 to 1.11),1.14(0.84 to 1.56)and 1.38(1.02 to 1.87)respectively(P trend=0.006).Subgroup analyses were carried out according to gender,diabetes,coronary heart disease,hyperlipidemia and eGFR,and the results showed that among women without coronary heart disease,with eGFR≤90 mL/(min·1.73 m 2)and with or without hyperlipidemia,participants with the highest quartile of SII(Q 4)had a significant higher risk of heart failure than those with Q 1(P trend<0.05).Conclusion SII may be independently associated with the prevalence rate of heart failure in elderly people with hypertension,and has guiding significance for clinical and nursing work.