论文部分内容阅读
目的 观察和分析俯身呼吸困难与射血分数(EF)正常的心力衰竭（HFnEF）患者预后的相关性。方法 入选HFnEF患者162例,按照有无俯身呼吸困难分为俯身呼吸困难组（n=82）和非俯身呼吸困难组（n=80），进行为期2年的随访，随访终点指标：全因性死亡/心源性死亡联合终点，心衰再入院治疗，心功能恶化至IV级，左室EF（LVEF）<50%，6分钟步行距离（6MWD）<300 m，血清N末端脑钠尿肽前体（NT-ProBNP）>1 200 ng/ml。Kaplan-Meier法描述生存率，Cox比例风险模型用以计算风险比（HR）及95%CI，分析俯身呼吸困难与心力衰竭患者临床结果的关系。结果 完全随访患者158例，失访4例，随访率97.5%，俯身呼吸困难组（n=80）和非俯身呼吸困难组（n=78）经Cox多因素分析校正后，两组间病死率无显著差异，俯身呼吸困难组的心衰再住院率显著高于非俯身呼吸困难组（24% vs. 18%，P<0.01），俯身呼吸困难组LVEF值<50%比例显著高于非俯身呼吸困难组（14% vs. 7%，P<0.05），俯身呼吸困难组心功能恶化至IV级的患者较非俯身呼吸困难组高（16% vs. 9%，P<0.05），俯身呼吸困难组血清NT-ProBNP>1 200 ng/ml，6MWD<300 m患者比例均显著高于非俯身呼吸困难组（13% vs. 10%，19% vs. 14%，均P<0.05）。结论 EF正常的心力衰竭患者中存在俯身呼吸困难者其心功能恶化风险升高。
Objective To observe and analyze the correlation between leaning difficulty breathing and the prognosis of patients with congestive heart failure (HFnEF) with normal ejection fraction (EF). Methods A total of 162 HFnEF patients were enrolled in this study. Two-year follow-up was performed in patients with HF (n = 82) and non-leaning dyspnea patients (n = 80) All-cause death / cardiogenic death combined endpoint, heart failure readmission, heart function worsening to grade IV, left ventricular EF (LVEF) & lt; 50%, 6 min walking distance Terminal Pro-Brain Natriuretic Peptide Precursor (NT-ProBNP) & gt; 1 200 ng / ml. Kaplan-Meier method was used to describe the survival rate. The Cox proportional hazards model was used to calculate the risk ratio (HR) and 95% CI. The relationship between leaning difficulty breathing and clinical outcome in patients with heart failure was analyzed. Results After complete follow-up, 158 patients were followed up, 4 patients were lost to follow-up, the follow-up rate was 97.5%. After correction by Cox multivariate analysis in the patients with dyspnea (n = 80) There was no significant difference in case fatality rate between the two groups. The re-admission rate of heart failure was significantly higher in patients with dyspnea than those without dyspnea (24% vs. 18%, P <0.01), LVEF <50% (14% vs. 7%, P & lt; 0.05). The patients whose dysfunction of heart function was worsened to grade IV than those who did not lean down (16% vs. 9 %, P <0.05). The mean NT-ProBNP> 1 200 ng / ml and 6MWD <300 m in patients who fell into the breath dyspnea group were significantly higher than those in the non-lean breathing group (13% vs. 10%, 19% vs 14%, both P & lt; 0.05). Conclusions There is an increased risk of worsening cardiac function in patients with normal EF and heart failure.