冠状动脉粥样硬化性心脏病患者心力衰竭危险因素分析

Risk factors for heart failure in patients with coronary atherosclerotic heart disease

目的探讨冠状动脉粥样硬化性心脏病患者发生心力衰竭的危险因素,并分析不同血压水平对心力衰竭发病风险的影响。方法选择2018年10月至2020年10月于秦皇岛市第一医院心血管科就诊的826例冠状动脉粥样硬化性心脏病患者为研究对象。根据是否发生心力衰竭将患者分为心力衰竭组(n=27)和非心力衰竭组(n=799),收集2组患者的临床资料,采用单因素和多因素logistic回归分析冠状动脉粥样硬化性心脏病患者发生心力衰竭危险因素。根据是否有高血压病史将患者分为高血压病史组(n=522)和血压正常组(n=304),进一步根据血压分级水平将患者分为血压正常组(n=304)、高血压1级组(n=102)、高血压2级组(n=254)和高血压3级组(n=166);比较各组患者心力衰竭累积发病率,并采用多因素Cox比例风险回归模型分析冠状动脉粥样硬化性心脏病患者是否有高血压病史及血压分级水平对发生心力衰竭的影响。结果单因素分析结果显示,心力衰竭组与非心力衰竭组患者高龄占比、高血压病史、吸烟史、冠状动脉病变情况、血红蛋白水平、左心房内径增大占比、左心室肥厚占比比较差异有统计学意义(P<0.05);2组患者的性别、高脂血症病史、体质量指数、糖尿病病史、白蛋白水平、血肌酐水平比较差异无统计学意义(P>0.05)。多因素logistic回归分析结果显示,高血压病史、高龄、冠状动脉多支病变(≥2支)、左心室肥厚是冠状动脉粥样硬化性心脏病患者发生心力衰竭的危险因素(P<0.05)。高血压病史组和血压正常组患者心力衰竭累积发病率分别为3.63%(19/522)、2.63%(8/304),高血压病史组患者心力衰竭累积发病率显著高于血压正常组(χ^(2)=6.792,P<0.05)。血压正常组、高血压1级组、高血压2级组、高血压3级组患者心力衰竭累积发病率分别2.63%(8/304)、2.94%(3/102)、3.54%(9/254)、4.22%(7/166),血压正常组、高血压1级组、高血压2级组、高血压3级组患者心力衰竭累积发病率呈逐渐升高趋势,两两比较差异均有统计学意义(P<0.05)。Cox比例风险模型中模型1(未校正混杂因素)、模型2(校正了年龄因素)、模型3(在模型2的基础上校正了高血压病史、吸烟史、冠状动脉病变情况、血红蛋白水平、左心房内径增大、左心室肥厚等混杂因素)结果均显示,高血压病史是冠状动脉粥样硬化性心脏病患者发生心力衰竭的影响因素,且血压水平越高,发生心力衰竭的危险度越高(P<0.05)。结论高血压病史、高龄、冠状动脉多支病变(≥2支)、左心室肥厚是冠状动脉粥样硬化性心脏病患者发生心力衰竭的危险因素,其中高血压病史的影响最大,且随着血压水平分级的升高,发生心力衰竭的风险增加。

Objective To investigate the risk factors for heart failure in patients with coronary atherosclerotic heart disease and to analyze the influence of different blood pressure levels on the risk of heart failure.Methods A total of 826 coronary atherosclerotic heart disease patients admitted to the Department of Cardiovascular Medicine of First Hospital of Qinhuangdao from October 2018 to October 2020 were selected as the research subjects.The patients were divided into the heart failure group(n=27)and the non-heart failure group(n=799)based on whether heart failure occurred.The clinical data of patients in the two groups were collected,and the risk factors for heart failure in patients with coronary atherosclerotic heart disease were analyzed by using the univariate and multivariate logistic regression.According to the history of hypertension,the patients were divided into the hypertension history group(n=522)and the normal blood pressure group(n=304),and according to the blood pressure levels,the patients were further divided into the normal blood pressure group(n=304),grade 1 hypertension group(n=102),grade 2 hypertension group(n=254)and grade 3 hypertension group(n=166).The cumulative incidence of heart failure of patients was compared among all groups,and the impact of hypertension history and blood pressure levels on the occurrence of heart failure in patients with coronary atherosclerotic heart disease was analyzed by using the multivariate Cox proportional hazards regression model.Results Univariate analysis showed that there were statistically significant differences in the proportion of advanced age,history of hypertension,history of smoking,coronary artery disease,hemoglobin level,proportion of left atrial enlargement,and proportion of left ventricular hypertrophy between the heart failure group and the non-heart failure group(P<0.05);and there was no significant difference in gender,history of hyperlipidemia,body mass index,history of diabetes,albumin level,and serum creatinine level between the two groups(P>0.05).Multivariate logistic regression analysis showed that the history of hypertension,advanced age,multivessel coronary artery disease(≥2 vessels),and left ventricular hypertrophy were risk factors for heart failure in patients with coronary atherosclerotic heart disease(P<0.05).The cumulative incidence of heart failure in the hypertension history group and the normal blood pressure group was 3.63%(19/522)and 2.63%(8/304),respectively;and the cumulative incidence of heart failure in the hypertension history group was significantly higher than that in the normal blood pressure group(χ^(2)=6.792,P<0.05).The cumulative incidence of heart failure in the normal blood pressure group,grade 1 hypertension group,grade 2 hypertension group,and grade 3 hypertension group was 2.63%(8/304),2.94%(3/102),3.54%(9/254),and 4.22%(7/166),respectively,showing an increasing trend,and there was a significant difference between each group(P<0.05).In the Cox proportional hazards model,model 1(unadjusted for confounding factors),model 2(adjusted for age factors),and model 3(adjusted for confounding factors such as the history of hypertension,history of smoking,coronary artery distase,hemoglobin level,left atrial enlargement,and left ventricular hypertrophy on the basis of model 2)all showed that the history of hypertension was the risk factor for heart failure in patients with coronary atherosclerotic heart disease,and the higher the blood pressure level,the higher the risk of developing heart failure(P<0.05).Conclusion The history of hypertension,advanced age,multivessel coronary artery disease(≥2 vessels),and left ventricular hypertrophy are risk factors for heart failure in patients with coronary atherosclerotic heart disease,among which the history of hypertension has the greatest influence,and the probability of developing heart failure increases as the blood pressure grade increases.