2024 年第 5 期 第 0 卷

握力水平与心力衰竭患者预后的相关性研究

Correlation between grip strength level and prognosis of patients with heart failure

作者：张文静 高蕴赫 王璐 张晶

英文作者：Zhang Wenjing Gao Yunhe Wang Lu Zhang Jing

单位：河北省唐山市中医医院心血管一科，唐山063000

英文单位：The First Department of Cardiovascular Tangshan Traditional Chinese Medicine Hospital Hebei Province Tangshan 063000 China

关键词：心力衰竭；握力；全因死亡；心力衰竭再住院

英文关键词：Heartfailure;Gripstrength;All-causedeath;Heartfailurerehospitalization

• 摘要：

• 目的  探索握力水平与心力衰竭患者预后的相关性。方法  选取2015年6月至2017年6月于河北省唐山市中医医院就诊的心力衰竭患者560例，根据患者握力的三分位间距分为3组，组1：握力＜18.9 kg（184例），组2：18.9 kg≤握力＜23.5 kg（188例），组3：握力≥23.5 kg（188例）。中位随访时间3年，主要终点为全因死亡和心力衰竭再住院。采用Kaplan-Meier生存分析明确握力水平与终点事件的关系。采用多因素Cox回归方法分析握力与心力衰竭患者预后的相关性。使用亚组分析探究握力水平在不同心力衰竭类型人群中对心力衰竭再住院结局的影响。绘制局部加权回归（Lowess）曲线评估握力与心力衰竭再住院风险的关系。结果  560例心力衰竭患者随访3年，共28例（5.0%）全因死亡，113例（20.2%）心力衰竭再住院。3组患者全因死亡发生率比较，差异无统计学意义（P=0.074），心力衰竭再住院发生率比较［25.0%(46/184)、21.3%(40/188)、14.4%(27/188)］，差异有统计学意义（P=0.034）。生存分析结果表明，在随访过程中，随着握力的升高，患者心力衰竭再住院发生率明显降低（Log-rank P=0.034）。多因素Cox回归分析结果表明，在纳入更多混杂因素后，高握力水平患者心力衰竭再住院发生风险仍可显著降低（组3比组1，P=0.004）。针对不同类型心力衰竭的亚组分析结果显示，在射血分数降低型心力衰竭和射血分数保留型心力衰竭亚组中，高握力水平患者心力衰竭再住院发生风险显著降低（均P＜0.05）。不同心力衰竭类型和握力分组之间无显著交互作用（交互P=0.568）。Lowess曲线表明，握力作为连续变量，与心力衰竭再住院的发生风险呈负相关。结论  在心力衰竭患者中，高握力水平患者心力衰竭再住院的发生风险显著降低。

• Objective  To explore the correlation between grip strength and prognosis of patients with heart failure. Methods  A total of 560 patients with heart failure in Tangshan Traditional Chinese Medicine Hospital, Hebei Province from June 2015 to June 2017 were selected. According to the tertile of grip strength, the patients were divided into three groups, group 1: grip strength < 18.9 kg (184 cases), group 2: 18.9 kg≤ grip strength< 23.5 kg (188 cases), and group 3: grip strength ≥ 23.5 kg (188 cases). The median follow-up time was 3 years. The main end points were all-cause death and heart failure rehospitalization. Kaplan-meier survival analysis was used to determine the relationship between grip strength level and endpoint events. Multivariate Cox regression was used to analyze the correlation between grip strength and prognosis of patients with heart failure. Subgroup analysis was used to explore the effect of grip strength on the outcomes of rehospitalization for heart failure in patients with different heart failure types. Locally weighted scatterplot smoothing (Lowess) curve was drawn to evaluate the relationship between grip strength and the risk of rehospitalization for heart failure. Results  A total of 560 patients with heart failure were followed up for 3 years, and 28 cases (5.0%) died from any cause and 113 cases (20.2%) were rehospitalized for heart failure. There was no statistically significant difference in the incidence of all-cause death among the three groups (P=0.074), and the incidence of rehospitalization for heart failure was statistically different ［25.0%(46/184), 21.3%(40/188), and 14.4%(27/188)］(P=0.034). Survival analysis result showed that with the increase of grip strength during follow-up, the incidence of rehospitalization for heart failure was significantly reduced (Log-rank P=0.034). Multivariate Cox regression analysis result showed that after more confounding factors were included, the risk of heart failure rehospitalization in patients with high grip strength was still significantly reduced (group 3 vs group 1, P=0.004). Subgroup analysis of different types of heart failure showed that patients with high grip strength had a significantly lower risk of heart failure rehospitalization in heart failure with reduced ejection fraction and heart failure with preserved ejection fraction (both P＜0.05). There were no significant interactions between heart failure type and grip strength group (interaction P=0.568). Lowess curve showed that grip strength, as a continuous variable, was inversely associated with the risk of heart failure rehospitalization. Conclusion  In patients with heart failure, patients with high grip strength have a significantly lower risk of heart failure rehospitalization.