2026 年第 8 期 第 21 卷

心力衰竭合并心房颤动患者肝纤维化指数4与死亡事件的相关性研究

Correlation between Fibrosis-4 index and mortality events in patients with heart failure complicated with atrial fibrillation

作者：冯阳阳王海诺蔡雪敏姚艳

英文作者：Feng Yangyang Wang Hainuo Cai Xuemin Yao Yan

单位：首都医科大学附属北京安贞医院心内科北京市心肺血管疾病研究所，北京100029

英文单位：Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China

关键词：心力衰竭；心房颤动；肝纤维化指数4；全因死亡率

英文关键词：Heartfailure;Atrialfibrillation;Fibrosis-4index;All-causemortality

• 摘要：

• 目的 探讨心力衰竭合并心房颤动患者肝纤维化指数4（FIB-4指数）与1年全因死亡率的关系。方法 从麻省理工学院维护的MIMIC-Ⅳ数据库中提取心力衰竭合并心房颤动患者的临床资料。根据FIB-4指数将患者分为低风险组（＜1.30）、中风险组（1.30～2.67）和高风险组（＞2.67）。主要结局为出院后1年全因死亡。采用Kaplan-Meier生存曲线比较不同组间的生存差异，通过多变量Cox比例风险模型评估FIB-4指数与死亡风险的独立关联，并运用限制性立方样条分析其剂量-反应关系。结果 本研究共纳入1 396例心力衰竭合并心房颤动患者，FIB-4指数低风险组190例（13.6%），中风险组611例（43.8%），高风险组595例（42.6%），其中441例（31.6%）在1年随访期内死亡。单因素Cox回归分析显示，FIB-4指数作为连续变量，每增加1个单位，死亡风险增加1.6%（风险比=1.016，95%置信区间：1.009～1.023，P＜0.001）。以低风险组为参照，高风险组死亡风险增加55.9%（风险比=1.559，95%置信区间：1.140～2.132，P=0.005）。多因素Cox回归校正协变量后，FIB-4指数仍与患者1年全因死亡独立相关（风险比=1.010，95%置信区间：1.003～1.018，P=0.009）。Kaplan-Meier生存曲线显示低风险组、中风险组和高风险组患者生存率差异有统计学意义（Log-rank P=0.003），高风险组生存率最低，中风险组次之，低风险组生存率最高。限制性立方样条分析表明FIB-4指数与死亡风险呈线性剂量-反应关系（非线性P=0.216）。结论 心力衰竭合并心房颤动患者FIB-4指数升高与1年全因死亡率相关，表明其可能作为这一高危人群的简单预后标志物。

• Objective To investigate the association between Fibrosis-4 (FIB-4) index and 1-year all-cause mortality in patients with heart failure combined with atrial fibrillation. Methods Clinical data of patients diagnosed with heart failure and atrial fibrillation were extracted from the MIMIC-Ⅳ database maintained by the Massachusetts Institute of Technology. Patients were stratified into low-risk group (<1.30), intermediate-risk group (1.30-2.67) and high-risk group (>2.67) according to FIB-4 index. The primary endpoint was 1-year all-cause mortality. Kaplan-Meier survival curves were used to compare survival disparities among groups. Multivariate Cox proportional hazards models were applied to evaluate the independent correlation between FIB-4 index and mortality risk, and restricted cubic splines were adopted to analyze the dose-response relationship. Results A total of 1 396 patients with heart failure and atrial fibrillation were enrolled, including 190 patients (13.6%) in the low-risk group, 611 patients (43.8%) in the intermediate-risk group, and 595 patients (42.6%) in the high-risk group. Among them, 441 patients (31.6%) died within the 1-year follow-up period. Univariate Cox regression analysis revealed that each one-unit increment in continuous FIB-4 index was associated with a 1.6% elevated mortality risk (hazard ratio=1.016, 95% confidence interval: 1.009-1.023, P＜0.001). Taking the low-risk group as the reference, the high-risk group exhibited a 55.9% increased mortality risk (hazard ratio=1.559, 95% confidence interval: 1.140-2.132, P=0.005). After adjustment for covariates in multivariate Cox regression, FIB-4 index remained independently correlated with 1-year all-cause mortality (hazard ratio=1.010, 95% confidence interval: 1.003-1.018, P=0.009). Kaplan-Meier survival curves demonstrated statistically significant differences in survival rates across the three groups (Log-rank P=0.003), with the high-risk group having the lowest survival rate, followed by the intermediate-risk group, and the low-risk group showing the highest survival rate. Restricted cubic spline analysis indicated a linear dose-response relationship between FIB-4 index and mortality risk (nonlinear P=0.216). Conclusion Elevated FIB-4 index is correlated with 1-year all-cause mortality in patients with heart failure complicated with atrial fibrillation, suggesting that FIB-4 index may serve as a simple prognostic biomarker for this high-risk population.