摘要
目的探讨血清白蛋白水平与接受心脏再同步化治疗（CRT）的心力衰竭（心衰）患者临床预后的关系。方法本研究为回顾性研究。连续入选阜外医院2010年1月至2015年12月首次行CRT植入术的心衰患者357例，收集其临床资料，并进行随访。随访终点定义为全因死亡（包括心脏移植）和心衰再住院。根据患者CRT术前血清白蛋白水平将患者分为白蛋白≥ 40 g/L组（n＝244）与白蛋白〈40 g/L组（n＝113），比较两组患者基线资料。对随访结果作生存分析和Cox回归分析以评价白蛋白水平对各终点事件的预测价值。结果随访结束时共45例患者（12.6%）死亡，4例（1.1%）行心脏移植，100例（28.0%）出现心衰再住院。两组患者相比，白蛋白〈40 g/L组患者纽约心脏协会（NYHA）心功能Ⅱ级较少，而NYHA心功能Ⅲ级患者较多。白蛋白≥40 g/L组患者血管紧张素转换酶抑制剂（ACEI）/血管紧张素Ⅱ受体拮抗剂（ARB）类药物使用率、血高密度脂蛋白胆固醇（HDL－C）水平较高。Kaplan－Meier生存分析结果显示白蛋白〈40 g/L组患者在全因死亡（log－rank检验：P＝0.000 4, χ2＝12.60）和心衰再入院（log－rank检验：P＝0.009, χ2＝ 6. 82）方面均劣于白蛋白≥ 40 g/L组。多因素Cox回归分析发现血清白蛋白〈40 g/L是CRT患者全因死亡（HR＝2.019, 95%CI 1.125～3.622, P＝0.018）和心衰再住院（HR＝1.517, 95%CI 1.014～2.270, P＝0.043）的独立危险因素。结论血清白蛋白水平与心衰CRT患者的严重程度相关，术前血清白蛋白水平较低的心衰CRT患者全因死亡及心衰再住院风险较大。
ObjectiveTo assess the relationship between serum albumin level and clinical outcome in heart failure （HF） patients receiving cardiac resynchronization therapy （CRT）.MethodsIn this retrospective cohort study, 357 consecutive chronic heart failure patients receiving CRT between January 2010 and December 2015 were enrolled and divided into two groups based on pre-CRT serum albumin （albumin≥40 g/L, n=244; albumin〈40 g/L, n=113）. Clinical outcomes were defined as all-cause mortality （including heart transplantation） and rehospitalization due to worsening HF.Baseline characteristics were compared and all-cause mortality （including heart transplantation） and rehospitalization due to worsening heart failure （HF） were analyzed using Kaplan-Meier curves.Prognostic value of albumin level was evaluated in Cox proportional-hazards regression models.ResultsOver a median follow-up time of 21 months, 45 patients （12.6%） died, 4 patients （1.1%） underwent heart transplantation and 100 patients （28.0%） were rehospitalized due to worsening HF. HF patients with pre-CRT albumin〈40 g/L were related with worse NYHA function class, lower HDL-C level and ACEI/ARB use compared to HF patients with pre-CRT albumin≥40 g/L. Kaplan-Meier analyses evidenced lower survival rate in HF patients （log-rank test： P=0.000 4, χ2=12.60） and higher rehospitalization rate due to worsening HF （log-rank test： P=0.009, χ2=6.82） in HF patients with pre-CRT albumin〈40 g/L.Multivariate Cox analyses indicated that serum pre-CRT albumin 〈40 g/L was an independent risk factor for all-cause mortality （HR=2.019, 95%CI 1.125-3.622, P=0.018） and HF rehospitalization （HR=1.517, 95%CI 1.014-2.270, P=0.043）.ConclusionPre-CRT serum albumin level is associated with the severity of heart failure in CRT recipients.Patients with lower pre-CRT albumin level face increased risk of all-cause mortality and HF rehospitalization in chronic heart failure patients receiving cardiac resynchronization.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2017年第3期204-208,共5页
Chinese Journal of Cardiology
