2022 年第 2 期 第 17 卷

衰弱对老年女性慢性射血分数保留型心力衰竭患者预后的影响

Effect of frailty on prognosis of elderly female patients with chronic heart failure with preserved ejection fraction

作者：曾琼琳王银凤周松

英文作者：Zeng Qionglin Wang Yinfeng Zhou Song

单位：华中科技大学同济医学院附属梨园医院导管室，武汉430077

英文单位：Catheter Room Liyuan Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology Wuhan 430077 China

关键词：心力衰竭；衰弱；主要不良心血管事件

英文关键词：Heartfailure;Frailty;Majoradversecardiovascularevents

• 摘要：

• 目的  探讨衰弱对老年女性慢性射血分数保留型心力衰竭（HFpEF）患者预后的影响。方法  选取2017年1月至2019年1月在华中科技大学同济医学院附属梨园医院诊治的老年女性慢性HFpEF患者。选择合并衰弱的70例患者为衰弱组；按照1∶2比例选择年龄、体重指数和左心室射血分数匹配的未合并衰弱的140例患者为对照组。随访12个月，记录主要不良心血管事件（MACE）发生情况，分析老年女性慢性HFpEF患者发生MACE的危险因素。结果  210例患者随访（11.3±2.2）个月，失访22例（10.5%）；86例（41.0%）发生MACE，包括5例全因死亡、65例因心力衰竭再入院和16例恶性心律失常。Kaplan-Meier生存分析结果提示，衰弱组患者的MACE发生率和因心力衰竭再入院率均明显高于对照组［51.4%（36/70）比35.7%（50/140）、40.0%（28/70）比26.4%（37/140）］（均P＜0.05）。多因素Cox回归模型分析结果显示，年龄、血肌酐、白蛋白、B型脑钠肽和衰弱是老年女性慢性HFpEF患者发生MACE的独立危险因素，而β受体阻滞剂是其独立保护因素（均P＜0.05）。结论  衰弱可显著增加老年女性慢性HFpEF患者的MACE发生风险，且为其独立危险因素。

• Objective To explore the effect of frailty on the prognosis of elderly female patients with chronic heart failure with preserved ejection fraction (HFpEF). Methods From January 2017 to January 2019, elderly female patients with chronic HFpEF admitted to Liyuan Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology were included. Seventy patients combined with frailty were selected as the frailty group; 140 patients without frailty matched by age, body mass index and left ventricular ejection fraction were selected as the control group according to the ratio of 1∶2. The occurrence of major adverse cardiovascular events (MACE) was recorded during 12 months follow-up, and the risk factors of MACE in elderly female with chronic HFpEF were analyzed. Results All patients were followed-up for (11.3±2.2) months, and 22 cases (10.5%) were lost. During the follow-up period, 86 cases (41.0%) had MACE, including 5 cases of all-cause deaths, 65 cases of readmissions due to heart failure and 16 cases of malignant arrhythmias. Kaplan-Meier survival analysis showed that the incidences of MACE and readmission due to heart failure in the frailty group were significantly higher than those in the control group［51.4%（36/70） vs 35.7%（50/140）, 40.0%（28/70） vs 26.4%（37/140）］(both P＜0.05). Multivariate Cox regression model showed that age, serum creatinine, albumin, brain natriuretic peptide and frailty were independent risk factors for MACE in elderly female patients with chronic HFpEF, while β receptor blockers was an independent protective factor (all P＜0.05). Conclusions Frailty is an independent risk factor to increase the incidence of MACE in elderly female patients with chronic HFpEF.