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目的观察射血分数正常心力衰竭(HFNEF)与射血分数下降心力衰竭(HFREF)的临床特征及预后。方法回顾性分析2008年2月-2011年2月因心力衰竭入住天津医科大学总医院心血管内科患者的临床资料并随访,经Cox回归模型多因素回归分析危险因素及与预后的关系。结果 483例心力衰竭患者中,HFNEF192例,占39.66%,HFREF291例,占60.34%。HFNEF组年龄([72±10)岁]、左室质量指数([132.93±42.74)g/m2]较HFREF组[年龄(69±12)岁、左室质量指数(108.63±31.20)g/m2]大,差异有统计学意义(P<0.01)。HFNEF组尿酸水平、肌酐水平、肌钙蛋白水平较HFREF组低,差异有统计学意义(P<0.05)。HFNEF组女性、高血压、心房颤动、糖尿病、瓣膜性心脏病、贫血患者比例高,冠状动脉性心脏病(CHD)患者比例低,差异均有统计学意义(P<0.01或P<0.05)。肥厚性心肌病患者均为HFNEF,扩张性心肌病患者均为HFREF,差异有统计学意义(P<0.01)。平均随访(23.24±8.9)月,两组心源性死亡率(包括急性心肌梗死、急性左心衰竭、恶性心律失常等)比较,差异无统计学意义(P=0.222)。经Cox回归模型多因素回归分析,NYHA分级、氨基末端脑肭肽前体(NT-proBNP)水平、体质指数(BMI)和CHD是HFREF患者预后的独立预测因素,心房颤动、NT-proBNP水平、女性及高血压是HFNEF患者预后的独立预测因素。结论 HFNEF与HFREF临床特征不同,影响预后的因素不同,预后相似。
Objective To observe the clinical characteristics and prognosis of HFNF and HFREF. Methods The clinical data of patients admitted to Tianjin Medical University General Hospital from February 2008 to February 2011 were retrospectively analyzed. Multivariate regression analysis was used to analyze the relationship between risk factors and prognosis. Results 483 HFNF patients, 192 cases of HFNEF, accounting for 39.66%, HFREF291 cases, accounting for 60.34%. The HFNEF group (mean age 72 ± 10 years) and LV mass index (132.93 ± 42.74 g / m2) were significantly longer in the HFREF group than those in the HFREF group [age 69 ± 12 years and 108.63 ± 31.20 g / m2 ] Large, the difference was statistically significant (P <0.01). The levels of uric acid, creatinine and troponin in HFNEF group were lower than those in HFREF group (P <0.05). The proportion of women with hypertension, atrial fibrillation, diabetes mellitus, valvular heart disease and anemia was higher in patients with HFNEF than in those with coronary heart disease (CHD). The differences were statistically significant (P <0.01 or P <0.05). Hypertrophic cardiomyopathy patients were HFNEF, dilated cardiomyopathy patients were HFREF, the difference was statistically significant (P <0.01). The average follow-up (23.24 ± 8.9) months, the two groups of cardiac mortality (including acute myocardial infarction, acute left heart failure, malignant arrhythmia, etc.), the difference was not statistically significant (P = 0.222). Multivariate regression analysis, NYHA classification, NT-proBNP level, body mass index (BMI) and CHD were independent predictors of prognosis in HFREF patients. Atrial fibrillation, NT-proBNP level, Women and high blood pressure are independent predictors of prognosis in patients with HFNEF. Conclusion The clinical features of HFNEF and HFREF are different, the factors affecting the prognosis are different, and the prognosis is similar.