老年高血压病人合并射血分数保留的心力衰竭的临床特征及相关危险因素分析

doi:10.3969/j.issn.1003-9198.2022.12.015

摘要/Abstract

摘要： 目的探讨老年高血压合并射血分数保留的心力衰竭(HFpEF)的临床特点及其相关危险因素。方法纳入569例老年高血压住院病人,根据是否合并HFpEF分为HFpEF组和对照组,比较2组间临床特点的差异;采用多元Logistic 回归分析老年高血压病人发生HFpEF的影响因素。结果 HFpEF组年龄、女性比例、超重、2型糖尿病患病率、血清B型尿钠肽、尿素氮、肌酐水平显著高于对照组(P＜0.05)。HFpEF组舒张期室间隔厚度、舒张期左心室内径、舒张期左心室后壁厚度、左心房内径、左心室质量指数均显著高于对照组(P＜0.01)。Logistic回归分析显示,老年高血压合并HFpEF的相关危险因素包括女性、超重、2型糖尿病及左心室质量指数。结论女性、超重、2型糖尿病、左心室质量指数是老年高血压病人合并HFpEF的相关危险因素。

关键词: 高血压, 射血分数保留的心力衰竭, 临床特征

Abstract: Objective To investigate the clinical characteristics and related risk factors of heart failure with preserved ejection fraction (HFpEF) in the elderly patients with hypertension. Methods A total of 569 elderly patients with hypertension were enrolled in this study. According to whether presenting with HFpEF, the patients were divided into HFpEF group and control group. The clinical characteristics of the two groups were analyzed. Multiple Logistic regression was used to analyze the risk factors of HFpEF in the elderly patients with hypertension. Results The age, proportion of female, overweight, type 2 diabetes mellitus, serum levels of B type natriuretic peptide, urea nitrogen and creatinine in HFpEF group were significantly higher than those in control group (P< 0.05). The diastolic ventricular septal thickness, diastolic left ventricular diameter, diastolic left ventricular posterior wall thickness, left atrial diameter and left ventricular mass index in HFpEF group were significantly higher than those in control group (P < 0.01). Logistic regression analysis showed that the related risk factors of HFpEF in the elderly hypertensive patients included female, overweight, type 2 diabetes mellitus and left ventricular mass index. Conclusions The incidence of HFpEF might be influenced by gender, overweight, type 2 diabetes mellitus and left ventricular mass index in the elderly hypertensive patients.

Key words: hypertension, heart failure with preserved ejection fraction, clinical characteristics

中图分类号:

张铭瑞, 崔雯霞, 高蕾, 李曼, 胡云. 老年高血压病人合并射血分数保留的心力衰竭的临床特征及相关危险因素分析[J]. 实用老年医学, 2022, 36(12): 1247-1250.

ZHANG Ming-rui, CUI Wen-xia, GAO Lei, LI Man, HU yun. Analysis of clinical characteristics and related risk factors of heart failure with preserved ejection fraction in elderly patients with hypertension[J]. Practical Geriatrics, 2022, 36(12): 1247-1250.

参考文献

[1] 中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018 [J]. 中华心力衰竭和心肌病杂志:中英文, 2018, 2(4): 196-225.
[2] 王华, 李莹莹, 柴坷, 等. 中国住院心力衰竭患者流行病学及治疗现状[J]. 中华心血管病杂志, 2019, 47 (11): 865-874.
[3] 季润青, 张丽华, 黄星荷, 等. 不同左心室射血分数心力衰竭住院患者的临床特征、诊疗情况及结局差异[J]. 中国循环杂志, 2021, 36(8): 769-774.
[4] ZHOU J M, LI X L, DONG Y G, et al. Abstract 10820: Real-world Characteristics of Patients With Heart Failure in China: Baseline Results From The Retrospective Non-interventional Nationwide Study (REPRESENT-HF). Circulation,2019, 140(Suppl 1): A10820.
[5] DEVEREUX R, ALONSO D, LUTAS E M, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings [J]. Am J Cardiol, 1986, 57(6): 450-458.
[6] 内分泌系统疾病基层诊疗指南编写专家组. 肥胖症基层诊疗指南(2019年)[J]. 中华全科医师杂志, 2020, 19(2): 95-101.
[7] MCDONAGH T A, METRA M, ADAMO M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure [J]. Eur Heart J, 2021, 42(36): 3599-3726.
[8] 周浩斌, 色珍, 白煜佳, 等. 射血分数减低和非射血分数减低心力衰竭患者的临床特征和预后[J]. 中华心力衰竭和心肌病杂志:中英文, 2018, 2(2): 65-70.
[9] PACKER M. The conundrum of patients with obesity, exercise intolerance, elevated ventricular filling pressures and a measured ejection fraction in the normal range [J]. Eur J Heart Fail, 2019, 21(2): 156-162.
[10] TROMP J, TENG T H, TAY W T, et al. Heart failure with preserved ejection fraction in Asia [J]. Eur J Heart Fail, 2019, 21(1): 23-36.
[11] SASAKI H, ASANUMA H, FUJITA M, et al. Metformin prevents progression of heart failure in dogs: role of AMP-activated protein kinase [J]. Circulation,2009, 119(19): 2568-2577.
[12] UNGER E D, DUBIN R F, DEO R, et al. Association of chronic kidney disease with abnormal cardiac mechanics and adverse outcomes in patients with heart failure and preserved ejection fraction [J]. Eur J Heart Fail, 2016, 18(1): 103-112.
[13] 王建枝.病理生理学[M]. 9版.北京:人民卫生出版社,2018:207-210.
[14] DAMMAN K, TESTANI J. The kidney in heart failure: an update [J]. Eur Heart J, 2015, 36(23): 1437-1444.
[15] OMOTE K, VERBRUGGE F H, BORLAUG B A. Heart failure with preserved ejection fraction: mechanisms and treatment strategies [J]. Annu Rev Med, 2022, 73: 321-337.
[16] CHIONCEL O, LAINSCAK M, SEFEROVIC P M, et al. Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC Heart Failure Long-Term Registry [J]. Eur J Heart Fail, 2017, 19(12): 1574-1585.
[17] LEE C J, PARK S. Hypertension and heart failure with preserved ejection fraction [J]. Heart Fail Clin, 2021, 17(3): 337-343.
[18] LAM C S, LYASS A, KRAIGHER-KRAINER E, et al. Cardiac dysfunction and noncardiac dysfunction as precursors of heart failure with reduced and preserved ejection fraction in the community [J]. Circulation, 2011, 124(1): 24-30.
[19] CHAMBERLAIN A M, BOYD C M, MANEMANN S M, et al. Risk factors for heart failure in the community: Differences by age and ejection fraction [J]. Am J Med, 2020, 133(6): e237-e248.