重症心力衰竭并发心房颤动的不良预后影响因素分析

Influence factors for poor prognosis in patients with severe heart failure complicated by atrial fibrillation

目的探讨重症心力衰竭并发心房颤动的不良预后影响因素。方法选择2022年6月至2024年6月于中国人民解放军海军第九七一医院接诊的200例重症心力衰竭并发心房颤动患者进行研究,据患者预后情况进行分组,1年内病情稳定或有所好转为预后良好组,设为对照组(n=146),1年内因心力衰竭出现病情加重或死亡则为预后不良组(n=54),收集患者临床资料,分析重症心力衰竭并发心房颤动不良预后的危险因素。结果单因素分析显示,两组患者年龄、性别、冠状动脉粥样硬化性心脏病(冠心病)、脑梗死、糖尿病、血红蛋白、糖化血红蛋白、左室射血分数比较,差异无统计学意义(P>0.05)。两组心功能分级、高血压、总胆红素、直接胆红素、N末端脑钠肽前体(NT-proBNP)、血管紧张素转换酶抑制剂/血管紧张素受体阻断剂(ACEI/ARB)及β受体阻滞剂比较差异显著(P<0.05)。多因素非条件Logistic分析显示,心功能分级、高血压、总胆红素、直接胆红素、NT-proBNP、ACEI/ARB及β受体阻滞剂均是重症心力衰竭并发心房颤动不良预后的独立危险因素(P<0.05)。结论重症心力衰竭并发心房颤动不良预后的独立危险因素较多,临床应重点关注危险因素,针对危险因素进行干预。

Objective To discuss the influence factors for poor prognosis in patients with severe heart failure complicated by atrial fibrillation(severe HF+AF).Methods The patients with severe HF+AF(n=200)were chosen from the 971st Hospital of Chinese PLA Navy from June 2022 to June 2024.The patients were divided into control group(n=146,with stable or improved condition within 1 y)and poor prognosis group(n=54,with exacerbated condition or died due to HF within 1 y).The clinical materials were collected from the patients,and risk factors for poor prognosis were analyzed in patients with severe HF+AF.Results The results of single-factor analysis showed that the differences in age,gender,coronary heart disease(CHD),cerebral infarction,diabetes,hemoglobin(Hb),glycated hemoglobin(HbAlc)and left ventricular ejection fraction(LVEF)had no statistical significance between 2 groups(P>0.05).The differences in heart function classification,hypertension,total bilirubin(TBIL),direct bilirubin(DBIL),N-terminal pro-brain natriuretic peptide(NT-proBNP),angiotensin converting enzyme inhibitor/angiotensin receptor blocker(ACEI/ARB)andβ-receptor blocker were significant between 2 groups(P<0.05).The results of multi-factor non-conditional Logistic analysis showed that heart function classification,hypertension,TBIL,DBIL,NT-proBNP,ACEI/ARB andβ-receptor blocker were independent risk factors for poor prognosis in patients with severe HF+AF(P<0.05).Conclusion There are many independent risk factors for poor prognosis in patients with severe HF+AF,and these risk factors need to be focused on and intervened in clinical practice.