老年射血分数保留型心力衰竭患者合并肌少症预后因素分析

doi:10.16138/j.1673-6087.2025.03.05

摘要/Abstract

摘要：

目的：分析上海部分地区老年射血分数保留型心力衰竭（心衰）（heart failure with preserved ejection fraction，HFpEF）患者合并肌少症的预后情况及相关危险因素。 方法：方法：连续选取2018年1月至2020年6月上海交通大学医学院附属瑞金医院及协作社区卫生服务中心、护理院住院收治的261例年龄≥60岁老年HFpEF患者，将受试者根据是否合并肌少症进行分组，收集受试者的相关临床资料。随访终点为受试者因心衰再入院和（或）全因死亡，随访截止时间为2022年12月。根据结果绘制Kaplan-Meier生存分析曲线并进行Log-Rank检验比较组间预后情况，应用单因素和多因素Cox比例风险回归模型分析不良预后的相关危险因素。 结果：2组平均随访（38.6±11.5）个月，肌少症组平均（37.4±13.0）个月，对照组平均（39.1±9.3）个月。Kaplan-Meier生存分析曲线结果显示肌少症组预后较无肌少症组明显更差（P<0.05），多因素Cox回归分析显示肌少症是老年HFpEF患者不良预后的独立危险因素（P<0.05）。 结论：肌少症是老年HFpEF患者不良预后的独立预测因子。在临床实践中应重视对老年HFpEF患者肌少症的早期识别与管理，可能有助于改善患者预后。

关键词: 射血分数保留型心力衰竭, 肌少症, 预后, 危险因素

Abstract:

Objective To explore the prognosis and related risk factors of sarcopenia in elderly patients with heart failure and preserved ejection fraction (HFpEF) in some areas of Shanghai. Methods A total of 261 elderly patients (age ≥60 years) with HFpEF were consecutively enrolled from January 2018 to June 2020 at Ruijin Hospital，Shanghai Jiao Tong University School of Medicine and collaborating community health service centers/nursing homes. The subjects were grouped according to the presence of sarcopenia, and the relevant clinical data were collected. The follow-up endpoint was subject’s readmission for heart failure and (or) all-cause death, and the deadline of follow-up was December 2022. The Kaplan-Meier survival analysis curve and Log-Rank test were performed to compare the outcome between the two groups, and univariate and multivariate Cox proportional hazards regression models were applied to analyze the relevant risk factors of adverse outcome. Results The average time of follow-up was (38.6±11.5) months in the two groups, was (37.4±13.0) months in the sarcopenia group and (39.1±9.3) months in the control group, respectively. The results of Kaplan-Meier survival analysis curve showed that the sarcopenia group had significantly worse prognosis than that in the control group (P<0.05), and multivariate Cox regression analysis showed that sarcopenia was an independent risk factor for poor prognosis in elderly patients with HFpEF (P<0.05). Conclusions This study indicates that sarcopenia was an independent predictor of adverse prognosis in elderly patients with HFpEF. These findings highlight the clinical importance of early identification and management of sarcopenia in these patients, which may help improve clinical outcomes.

Key words: Heart failure with preserved ejection fraction, Sarcopenia, Prognosis, Risk factor

中图分类号:

R541.6

杨启瑞, 白婷婷, 蒋倩雯, 张伟奇, 鲁怡音, 赵伟, 吴方, 李菲卡. 老年射血分数保留型心力衰竭患者合并肌少症预后因素分析[J]. 内科理论与实践, 2025, 20(03): 210-215.

YANG Qirui, BAI Tingting, JIANG Qianwen, ZHANG Weiqi, LU Yiyin, ZHAO Wei, WU Fang, LI Feika. Prognostic factor analysis of sarcopenia in elderly patients with heart failure and preserved ejection fraction[J]. Journal of Internal Medicine Concepts & Practice, 2025, 20(03): 210-215.

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项目	非肌少症组(n=174)	肌少症组(n=87)	合计(n=261)	χ²/Z/t	P
性别				0.21	0.774
男性	142	73	215
女性	32	14	46
年龄	86.5 (81~91)	90.0 (86~95)	88.0 (81~95)	-4.30	<0.001
原发性高血压[n(%)]	131 (75.29)	65 (74.71)	196 (75.10)	-0.25	0.858
糖尿病[n(%)]	74 (42.53)	39 (44.83)	113 (43.30)	-0.85	0.380
冠心病[n(%)]	88 (50.57)	45 (51.72)	133 (50.96)	-0.33	0.772
血红蛋白(g/L)	125.5 (109.0~140.0)	123.0 (110.5~136.0)	124.0(109.0~140.0)	-0.88	0.379
1,25-OH-VitD₃(nmol/L)	47.6(36.3~57.3)	36.1(26.0~48.1)	44.5(26.0~57.3)	-4.31	<0.001
Hcy(μmol/L)	11.4 (9.6~13.9)	18.3 (13.3~22.2)	12.8 (9.6~22.2)	-6.98	0.192
血清白蛋白(g/L)	38 (34~40)	37 (33~39)	37 (33~40)	-1.71	0.088
血肌酐(μmol/L)	91 (78~111)	84 (72~100)	87 (72~111)	-3.04	0.002
CRP(mg/L)	3 (1.0~11.8)	2 (0.7~7.5)	2.19 (0.7~11.6)	-1.58	0.114
pro-BNP(pg/mL)	404.2(187.6~1 009.5)	398.4(189.0~884.3)	402.0(187.6~1 009.5)	-0.10	0.921
BMI(kg/m²)	25.6±3.0	22.1±3.4	24.4±3.5	8.70	<0.001
SMI(kg/m²)	7.8 (7.4~8.7)	6.4 (5.9~6.7)	7.4 (5.9~8.7)	-11.53	<0.001
步速(m/s)	1 (0.7~1.2)	0.7 (0.5~0.9)	0.89(0.5~1.2)	-5.30	<0.001
手握力(kg)	28.6±8.7	21.7±5.5	26.3±8.4	7.91	<0.001
SPPB评分(分)	11 (8~12)	8 (5~10)	10 (5~12)	-4.81	<0.001

项目	HR	CI	P
性别	0.952	0.512~1.740	0.873
年龄	1.106	1.064~1.148	<0.001
血红蛋白	0.981	0.971~0.992	<0.001
1,25-OH-VitD₃	0.986	0.975~1.001	0.061
Hcy	1.013	0.982~1.046	0.415
血清白蛋白	0.903	0.857~0.951	<0.001
血肌酐	0.998	0.993~1.003	0.360
CRP	1.003	0.995~1.010	0.500
BNP	1.000	1.000~1.000	0.004
BMI	0.969	0.911~1.031	0.323
SMI	0.843	0.704~1.009	0.063
肌少症	1.843	1.158~2.933	0.010
步速	0.162	0.081~0.324	<0.001
手握力	0.971	0.946~0.997	0.029
SPPB评分	0.853	0.797~0.913	<0.001

项目	HR	CI	P
血红蛋白	0.996	0.982~1.010	0.547
血清白蛋白	0.944	0.885~1.006	0.077
BNP	1.000	1.000~1.000	0.226
肌少症	1.578	0.919~2.710	0.010
步速	0.229	0.078~0.670	0.007
手握力	1.029	0.992~1.067	0.126
SPPB评分	0.958	0.865~1.062	0.416