铁缺乏对高龄射血分数保留型心力衰竭患者预后的影响

Effect of iron deficiency on the prognosis of elderly patients with ejection fraction preserved heart failure

目的探讨铁缺乏对高龄射血分数保留型心力衰竭(HFpEF)患者预后的影响。方法回顾性分析2021年11月至2023年5月中国人民解放军东部战区总医院>75岁HFpEF患者的临床资料。患者根据入院时铁蛋白(SF)和转铁蛋白饱和度(TSAT)分为铁缺乏组(65例)和非铁缺乏组(90例)。比较两组入院后首次血液学指标和超声心动图检查结果。患者随访截止2023年11月,记录不良预后情况。采用Spearman法分析铁缺乏和铁代谢指标与高龄HFpEF患者不良预后的相关性;绘制Kaplan-Meier生存曲线,分析铁缺乏对高龄HFpEF患者累积生存率的影响。结果两组三酰甘油、总胆固醇、低密度脂蛋白胆固醇、C反应蛋白、血红蛋白和超声心动图指标比较差异无统计学意义(P>0.05);铁缺乏组氨基末端脑钠肽前体(NT-proBNP)、肌酐、降钙素原(PCT)和白细胞介素-6(IL-6)明显高于非铁缺乏组[427.23(281.00,736.90)pmol/L比313.50(182.47,363.25)pmol/L、(167.93±51.22)μmol/L比(121.71±11.99)μmol/L、0.12(0.05,0.22)μg/L比0.07(0.04,0.16)μg/L和25.60(8.38,47.01)ng/L比10.15(4.75,19.89)ng/L],SF、血清铁(SI)和TSAT明显低于非铁缺乏组[75.40(42.30,198.00)μg/L比207.00(281.00,736.90)μg/L、(6.49±2.66)μmol/L比(12.75±4.24)μmol/L和(16.65±6.26)%比(33.78±11.16)%],差异有统计学意义(P<0.01或<0.05)。患者随访(12.06±7.58)个月,铁缺乏组全因病死率、心血管病死率、再入院率和心力衰竭再入院率明显高于非铁缺乏组[40.0%(26/65)比20.0%(18/90)、18.5%(12/65)比4.4%(4/90)、90.8%(59/65)比70.0%(63/90)和66.2%(43/65)比17.8%(16/90)],差异有统计学意义(P<0.01)。Spearman相关分析结果显示,铁缺乏与高龄HFpEF患者全因死亡、心血管死亡、再入院和心力衰竭再入院呈正相关(P<0.01);SI和TSAT与全因死亡、心血管死亡、再入院和心力衰竭再入院呈负相关(P<0.01或<0.05);SF与全因死亡、心血管死亡、再入院和心力衰竭再入院无相关性(P>0.05)。Kaplan-Meier生存曲线分析结果显示,合并铁缺乏的高龄HFpEF患者全因死亡风险明显增加,累计生存率降低(log-rankχ^(2)=6.48,P<0.05)。结论高龄HFpEF合并铁缺乏患者预后不良,病死率和再入院率高。

Objective To investigate the effect of iron deficiency on the prognosis of elderly patients with ejection fraction preserved heart failure(HFpEF).Methods The clinical data of old patients(>75 years)with HFpEF from November 2021 to May 2023 in General Hospital of Eastern Theater of the Chinese People′s Liberation Army were retrospectively analyzed.The patients were divided into iron deficiency group(65 cases)and non-iron deficiency group(90 cases)according to serum ferritin(SF)and transferrin saturation(TSAT)at admission.The first hematological indexes and echocardiogram examination results after admission were compared between two groups.The patients were followed up until November 2023,the poor prognosis was recorded.The correlation between iron deficiency,iron metabolism indexes and poor prognosis in elderly patients with HFpEF was analyzed by Spearman correlation analysis.The Kaplan-Meier survival curve was drawn to analyze the effect of iron deficiency on the cumulative survival in elderly patients with HFpEF.Results There were no statistical difference in triglyceride,total cholesterol,low density lipoprotein cholesterol,C-reactive protein,hemoglobin and echocardiogram indexes between the two groups(P>0.05).The N-terminal pro-brain natriuretic peptide(NT-proBNP),creatinine,procalcitonin(PCT)and interleukin-6(IL-6)in iron deficiency group were significantly higher than those in non-iron deficiency group:427.23(281.00,736.90)pmol/L vs.313.50(182.47,363.25)pmol/L,(167.93±51.22)μmol/L vs.(121.71±11.99)μmol/L,0.12(0.05,0.22)μg/L vs.0.07(0.04,0.16)μg/L and 25.60(8.38,47.01)ng/L vs.10.15(4.75,19.89)ng/L,the SF,serum iron(SI)and TSAT were significantly lower than those in non-iron deficiency group:75.40(42.30,198.00)μg/L vs.207.00(281.00,736.90)μg/L,(6.49±2.66)μmol/L vs.(12.75±4.24)μmol/L and(16.65±6.26)%vs.(33.78±11.16)%,and there were statistical differences(P<0.01 or<0.05).The patients were followed up for(12.06±7.58)months,the all-cause mortality,cardiovascular mortality,readmission rate and heart failure readmission rate in iron deficiency group were significantly higher than those in non-iron deficiency group:40.0%(26/65)vs.20.0%(18/90),18.5%(12/65)vs.4.4%(4/90),90.8%(59/65)vs.70.0%(63/90)and 66.2%(43/65)vs.17.8%(16/90),and there were statistical differences(P<0.01).Spearman correlation analysis result showed that the iron deficiency was positive correlation with all-cause death,cardiovascular death,readmission and heart failure readmission in elderly patients with HFpEF(P<0.01);the SI and TSAT were negative correlation with all-cause death,cardiovascular death,readmission and heart failure readmission(P<0.01 or<0.05);and the SF was not correlation with the indexes(P>0.05).Kaplan-Meier survival analysis result showed that the risk of all-cause death was significantly increased in elderly HFpEF patients with iron deficiency,and the cumulative survival rate was significantly reduced(log-rankχ^(2)=6.48,P<0.05).Conclusions The elderly HFpEF patients with iron deficiency have poor prognosis with high mortality and readmission rate.