总胆红素水平对住院慢性心力衰竭患者远期预后影响

Abstract

目的 探讨住院慢性心力衰竭(CHF)患者TBil水平与远期预后的关系.方法 回顾性分析140例CHF急性加重患者入院24 h内血液学检查及心脏结构及功能参数,平均随访28.5个月,分析远期死亡的预测因子.结果 入院时TBil≤12.8 mmol/L组、TBil＞ 12.8 ～ 18.2 mmol/L组、TBil＞ 18.2 mmol/L组远期病死率分别为12.2％、17.9％和38.9％ (P =0.002),脉压分别为(55.5±17.3、48.9±13.1、46.1±13.7)mm Hg(1 mm Hg =0.133 kPa) (P =0.008).相关性分析显示TBil与右室内径、左室舒张末期内径明显相关(r分别为0.34、0.23).多因素分析显示TBil和利钠肽是死亡的独立预测因子(P值分别为0.038、0.027).结论 CHF急性加重时,TBil水平增高预测其远期病死率增加.

Objective To analyze the relationship between serum total bilirubin coincident with congestive heart failure (CHF) exacerbation and subsequent long-term mortality in patients with CHF.Methods The study population consisted of 140 consecutive patients admitted for CHF exacerbation with left ventricular ejection fraction ≤45％.They were divided into 2 groups according to whether death attacked or not in the following 28.5 months. Binary logistic regression analysis was used to investigate independent predictors of death from clinical parameters on admission or within 24 hours. Results Serum TBil and B-type natriuretic peptide (BNP) levels on admission were independent predictors of subsequent death after hospital discharge.According to increasing textiles of TBil stratified by the level of 12.8 and 18.2 mmol/L,the patients were divided into 3 groups:lower-level group (TBil ≤ 12.8 mmol/L),moderate-level group (TBil ＞ 12.8 ～ 18.2 mmol/L) and higher-level group (TBil ＞ 18.2 mmoL/L),with the death rates after 28.5 months of 12.2％,17.9％ and 38.9％,respectively ( P =0.002 ). Meanwhile,the pulse pressure decreased to (55.5 ± 17.3) mm Hg (1 mm Hg =0.133 kPa),(48.9 ± 13.1) mm Hg and (46.1 ± 13.7)mm Hg,respectively ( P =0.008 ). TBil on admission had significant correlation with echocardiographymeasured left ventricular endo-diastolic diameter ( r =0.34,P =0.000 ) and right ventricular diastolic diameter (r =0.23,P =0.011 ). Conclusions Increased TBil coincident with cardiac decompensation predicts a worse long-term death of CHF,presumably through the potential liability to both decompensated RV function and lower cardiac output syndrome occurred simultaneously when HF deteriorates.