2021 年第 8 期 第 16 卷

体位性低血压对老年心力衰竭患者长期预后的影响

Effect of orthostatic hypotension on long-term prognosis of elderly patients with heart failure

作者：屈超阙斌李响蒲连美刘飞张晶齐疏影

英文作者：Qu Chao Que Bin Li Xiang Pu Lianmei Liu Fei Zhang Jing Qi Shuying

单位：首都医科大学附属北京安贞医院急诊危重症中心100029

英文单位：Emergency Critical Care Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：体位性低血压；心力衰竭；老年；卒中；危险因素 

英文关键词：Orthostatichypotension;Heartfailure;Elderly;Stroke;Riskfactors

• 摘要：

• 目的 探讨体位性低血压（OH）对老年心力衰竭患者长期主要不良心脑血管事件（MACCE）的影响，并分析影响MACCE的危险因素。方法 本研究为回顾性队列研究，连续纳入2015年1月至2018年1月在首都医科大学附属北京安贞医院诊治的老年心力衰竭患者。依据是否合并OH，选择100例合并OH的老年心力衰竭患者为OH组，并按照1∶2比例选择同期入院、年龄和左心室射血分数匹配的未合并OH的200例老年心力衰竭患者为对照组。随访截止至2019年12月，记录MACCE发生情况，包括全因死亡、因心力衰竭再次入院、急性心肌梗死、卒中和恶性心律失常。比较2组MACCE发生情况，分析影响MACCE的危险因素。结果 OH组合并高血压、糖尿病比例，空腹血糖、卧位收缩压和舒张压水平明显高于对照组，立位收缩压和舒张压水平、应用利尿剂比例低于对照组（均P＜0.05）。所有患者随访（28±15）个月，失访29例（9.7%）。随访期间，共有107例（35.7%）患者发生MACCE。OH组因心力衰竭再次入院、卒中发生率及MACCE总发生率均明显高于对照组［27.0%(27/100)比11.5%(23/200)、6.0%(6/100)比2.0%(4/200)、53.0%(53/100)比27.0%(54/200)］（均P＜0.05）。多因素Cox比例风险回归模型分析结果显示，OH是老年心力衰竭患者随访发生MACCE的独立危险因素（风险比=1.779，95%置信区间：1.165～2.717,P=0.008）。结论 OH可显著增加老年心力衰竭患者的心力衰竭再入院率和卒中发生风险，且为MACCE的独立危险因素。

• Objective To explore the effect of orthostatic hypotension (OH) on long-term major adverse cardiovascular and cerebrovascular events (MACCE) in elderly patients with heart failure (HF), and to analyze the risk factors of MACCE. Methods This was a retrospective cohort study. From January 2015 to January 2018, elderly HF patients who were diagnosed and treated in Beijing Anzhen Hospital, Capital Medical University were continuously enrolled. According to whether combined with OH or not, 100 HF elderly patients with OH were selected as the OH group, and 200 HF elderly patients admitted in the same period with matching age and left ventricular ejection fraction without OH were selected as the control group according to the ratio of 1∶2. By  the end of follow-up in December 2019, the incidence of MACCE were recorded, including all-cause death, readmissions due to HF, acute myocardial infarction, stroke, and malignant arrhythmia. The incidence of MACCE was compared between the two groups, and the risk factors of MACCE were analyzed. Results The rates of complicated with hypertension and diabetes mellitus, fasting blood glucose, supin systolic and diastolic blood pressure levels in OH group were significantly higher than those in control group; orthostatic systolic and diastolic blood pressure levels and rate of diuretics used in OH group were lower than those in control group (all P＜0.05). Patients were followed-up for (28±15) months, and 29 cases(9.7%) were lost to follow-up. During the follow-up period, a total of 107 patients (35.7%) had MACCE. The incidences of readmission due to HF, stroke and total incidence of MACCE in OH group were significantly higher than those in control group［27.0%(27/100) vs 11.5%(23/200), 6.0%(6/100) vs 2.0%(4/200), 53.0%(53/100) vs 27.0%(54/200)］（all P＜0.05）. The multivariate Cox proportional hazards regression model analysis showed that OH was an independent risk factor for MACCE in elderly patients with HF during follow-up period(hazard ratio=1.779, 95% confidence interval: 1.165-2.717, P=0.008). Conclusion OH can significantly increase the readmission rate due to HF and the risk of stroke in elderly patients with HF, and it is an independent risk factor for MACCE.