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血脂水平对老年冠心病心力衰竭患者预后的影响

宋芳,王林   

  1. 天津医科大学第二医院
  • 收稿日期:2011-08-04 修回日期:2011-11-10 出版日期:2012-07-15 发布日期:2012-07-15
  • 通讯作者: 宋芳

Relationship of lipids and prognosis in elder patients of chronic heart failure with coronary artery disease

  • Received:2011-08-04 Revised:2011-11-10 Published:2012-07-15 Online:2012-07-15

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摘要： 摘要 目的：研究血脂水平与老年冠心病慢性心力衰竭患者预后的关系。 方法：选择2005年1月—2007年12月入住我科的老年冠心病合并慢性心衰患者970例。按血脂水平的四分位间距将各血脂指标均分为低水平组、较低水平组、较高水平组和高水平组。按随访期是否死亡分为死亡组（206例）和生存组（764例），按随访期间使用他汀类药物情况分为他汀组（531例）和非他汀组（439例），比较四项血脂成份各水平组的病死率。采用多因素Cox回归分析血脂对冠心病合并心衰患者预后的影响。 结果：在他汀组和非他汀组，各高密度脂蛋白胆固醇（HDL-C）水平的病死率差异有统计学意义（P＜0.05），总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）各水平组的病死率差异无统计学意义（P＞0.05）。死亡组的年龄，合并陈旧性心肌梗死（OMI）、贫血、房颤、肾衰竭的比例大于生存组；死亡组的HDL-C、射血分数（EF），服用血管紧张素转换酶抑制剂（ACEI）/血管紧张素Ⅱ受体拮抗剂（ARB）类和他汀类药物的比例小于生存组，差别有统计学意义（P<0.05或P<0.01）。年龄、NYHAⅢ～Ⅳ级、低水平和较低水平的HDL-?C是冠心病心衰预后不良的危险因素，ACEI/ARB为保护因素，TG、TC、LDL-C各水平组对预后无明显影响。结论：提高HDL-C水平可能改善冠心病心衰患者的预后，TC、TG、LDL-C水平对冠心病心衰患者预后无明显影响。

关键词: 冠心病, 心力衰竭, 胆固醇, 胆固醇, LDL, 胆固醇, HDL, 甘油三酯类

Abstract: Abstract Objective:To study the association between the lipid levels and prognosis in elder patients with chronic heart failure（CHF） who had coronary artery disease（CAD）. Methods:970 patients enrolled from the cardiology department of 2nd Hospital Tianjin Medical University who had clinical diagnoses of CHF with CAD from January 2005 to December 2007. Total cholesterol (TC), Triglycerides(TG), Low-density lipoprotein cholesterol (LDL-C) and High-density lipoprotein cholesterol (HDL-C) were divided into quartile. Patients were grouped with death (206 cases) and living (764 cases). According to statin-using，compared the mortality in various lipid levels, statin groupe (531 cases) and non statin groupe (439 cases). Cox regression analysis was used to confirm the associations of lipid levels and prognosis of the patients. Results:The different of mortality in each level of HDL-C was significant (P＜0.05), but there was no significant association between the levels of the TC, TG, LDL-C and prognosis (P＞0.05). Compared with living groupe, death patients were older, had more proportion of old myocardial infarction, anemia, atrial fibrillation and renal failure, while had lower HDL-C level and ejection factor, less using of angiotensin converting enzyme inhibitor(ACEI)/Angiotension receptor blocker(ARB) and statin (P<0.05 or P<0.01). Multivariate Cox regress analysis showed age, NYHAⅢ～Ⅳ, the lowest and the lower level HDL-C had significantly greater survival. ACEI/ARB was protected factor for prognosis. But none of the quartiles of TC or TG or LDL-C could predict for the mortality. Conclusion:Our study shows HDL-C represented a novel prognostic factor for patients with advanced heart failure. TC, TG and LDL-C were not related to the prognosis of heart failure.

Key words: coronary diseaseheart failurecholesterol cholesterol, LDL cholesterol, HDLtriglycerides statinsprognosis, 甘油三酯类