老年慢性心力衰竭患者并发心肾综合征的高危因素及预防对策

High risk factors and prevention strategies for cardiovascular and renal syndrome in elderly patients with chronic heart failure

目的探讨老年慢性心力衰竭患者并发心肾综合征的高危因素及预防对策,构建相关预测模型,探索其预测价值。方法回顾性分析2021年1月至2023年6月金华市第二医院收治的155例老年慢性心力衰竭患者的临床资料,根据是否发生心肾综合征分为并发组(41例)和未并发组(114例)。采用单因素和logistic回归分析老年慢性心力衰竭患者并发心肾综合征的影响因素,并构建预测模型,用受试者工作特征(ROC)曲线分析预测模型对老年慢性心力衰竭患者并发心肾综合征的预测价值。结果单因素分析发现,并发组与未并发组心功能分级、是否合并糖尿病、有无贫血、有无急性感染、血清超敏C反应蛋白(hs-CRP)、全血尿酸(UA)、血肌酐(Cr)水平及左心室射血分数(LVEF)比较,差异有统计学意义(P<0.05)。logistic回归分析结果显示,心功能分级Ⅲ级或Ⅳ级、合并糖尿病、贫血、急性感染、血清hs-CRP、全血UA、Cr水平高及LVEF低是老年慢性心力衰竭患者并发心肾综合征的独立危险因素(P<0.05)。构建预测模型:logit(P)=-10.691+心功能分级Ⅲ或Ⅳ级×1.378+合并糖尿病×0.913+贫血×0.512+急性感染×1.684+血清hs-CRP水平高×0.812+全血UA水平高×1.311+全血Cr水平高×0.894+LVEF低×0.796。ROC曲线分析结果显示,当logit(P)>9.14时,曲线下面积为0.900(95%CI:0.842~0.942)。结论老年慢性心力衰竭患者并发心肾综合征与心功能分级Ⅲ级或Ⅳ级、合并糖尿病、贫血、急性感染、血清hs-CRP、UA、Cr水平高及LVEF低密切相关,据此建立的预测模型有较好的预测价值。

Objective To explore the high-risk factors and prevention strategies for cardiovascular and renal syndrome in elderly patients with chronic heart failure,and to construct relevant predictive models to explore their predictive value.Methods A retrospective analysis was conducted on the clinical data of 155 elderly patients with chronic heart failure admitted to the Second Hospital of Jinhua from January 2021 to June 2023.They were divided into a concurrent group(41 cases)and a non concurrent group(114 cases)based on the occurrence of cardiorenal syndrome.univariate and logistic regression analysis to investigate the influencing factors of cardiovascular and renal syndrome in elderly patients with chronic heart failure were used,and constructed a predictive model.The receiver operating characteristic curve(ROC)was used to analyze the predictive value of the predictive model for cardiovascular and renal syndrome in elderly patients with chronic heart failure.Results The univariate analysis showed that there were statistically significant differences in heart function grading,diabetes,anemia,acute infection,serum high-sensitivity C-reactive protein(hs-CRP),whole blood uric acid(UA),serum creatinine(Cr)and left ventricular ejection fraction(LVEF)between the concurrent group and the non concurrent group,P<0.05.Logistic regression analysis showed that the independent risk factors of elderly patients with chronic heart failure complicated with cardiorenal syndrome were cardiac function gradeⅢorⅣ,diabetes,anemia,acute infection,high serum hs-CRP,high whole blood UA,Cr levels,and low LVEF(P<0.05).The prediction model was constructed:logit(P)=-10.691+cardiac function gradeⅢorⅣ×1.378+diabetes×0.913+anemia×0.512+acute infection×1.684+high serum hs CRP level×0.812+high whole blood UA level×1.311+high whole blood Cr level×0.894+low LVEF×0.796.The ROC curve analysis results show that when logit(P)>9.14,the area under the curve(AUC)value is 0.900(95%CI is 0.842-0.942).Conclusions The elderly patients with chronic heart failure complicated with cardiorenal syndrome are closely related to cardiac function gradeⅢorⅣ,diabetes,anemia,acute infection,high levels of serum hs-CRP,whole blood UA,Cr,and low LVEF.The prediction model established on this basis has a good predictive value.