中华内科杂志
中華內科雜誌
중화내과잡지
Chinese Journal of Internal Medicine
2015年
11期
959-964
,共6页
于彤彤%宋娇磊%刘双双%王传合%王菁菁%韩苏%孙兆青%孙志军
于彤彤%宋嬌磊%劉雙雙%王傳閤%王菁菁%韓囌%孫兆青%孫誌軍
우동동%송교뢰%류쌍쌍%왕전합%왕정정%한소%손조청%손지군
血清白蛋白%心力衰竭%医院死亡率%倾向性评分匹配法
血清白蛋白%心力衰竭%醫院死亡率%傾嚮性評分匹配法
혈청백단백%심력쇠갈%의원사망솔%경향성평분필배법
Serum albumin%Heart failure%Hospital mortality%Propensity score matching
目的 探讨血清白蛋白对心力衰竭(心衰)患者院内死亡的影响.方法 连续入选2 430例住院心衰患者,按血清白蛋白水平分为白蛋白正常组(血清白蛋白≥35g/L)、低白蛋白组(血清白蛋白＜ 35 g/L).以院内全因死亡为主要终点,使用倾向性评分匹配法对两组患者进行匹配,得到组间协变量均衡的样本,通过多因素Cox回归分别评价匹配前后血清白蛋白对院内死亡的影响.结果 2 430例入选患者,年龄(68±14)岁,共631例存在低白蛋白,占26.0％.匹配前,与白蛋白正常组相比,临床特征方面,低白蛋白组年龄更大,纽约心功能分级、院内病死率更高,扩张性心肌病、瓣膜病、螺内酯应用更多,高血压者更少,入院收缩压更低,入院心率更快,病程更长;实验室检查方面,低白蛋白组直接胆红素、碱性磷酸酶、谷氨酰转肽酶、肌酐、尿酸、尿素、B型利钠肽更高,血红蛋白、胆固醇、血钠、入院左心室射血分数更低.使用倾向性评分匹配法,两组共631对匹配成功,两组间不平衡的协变量经匹配后均达到平衡.匹配前,白蛋白正常组院内病死率为1.2％,低白蛋白组为5.7％,在校正了所有临床因素后,Cox回归分析显示,白蛋白每下降1 g/L,心衰患者的院内死亡风险增加12.0％(HR 1.120,95％ CI1.057～1.186;P＜0.001).匹配后,白蛋白正常组院内病死率为2.9％,低白蛋白组为5.7％,在校正了所有临床因素后,Cox回归分析显示,白蛋白每下降1 g/L,心衰患者的院内死亡风险仍增加11.0％(HR1.110,95％ CI1.043～1.181;P =0.001).结论 血清白蛋白本身对心衰患者的预后存在影响,是心衰患者院内死亡的独立危险因素,纠正低白蛋白可以降低心衰患者的院内死亡风险.
目的 探討血清白蛋白對心力衰竭(心衰)患者院內死亡的影響.方法 連續入選2 430例住院心衰患者,按血清白蛋白水平分為白蛋白正常組(血清白蛋白≥35g/L)、低白蛋白組(血清白蛋白＜ 35 g/L).以院內全因死亡為主要終點,使用傾嚮性評分匹配法對兩組患者進行匹配,得到組間協變量均衡的樣本,通過多因素Cox迴歸分彆評價匹配前後血清白蛋白對院內死亡的影響.結果 2 430例入選患者,年齡(68±14)歲,共631例存在低白蛋白,佔26.0％.匹配前,與白蛋白正常組相比,臨床特徵方麵,低白蛋白組年齡更大,紐約心功能分級、院內病死率更高,擴張性心肌病、瓣膜病、螺內酯應用更多,高血壓者更少,入院收縮壓更低,入院心率更快,病程更長;實驗室檢查方麵,低白蛋白組直接膽紅素、堿性燐痠酶、穀氨酰轉肽酶、肌酐、尿痠、尿素、B型利鈉肽更高,血紅蛋白、膽固醇、血鈉、入院左心室射血分數更低.使用傾嚮性評分匹配法,兩組共631對匹配成功,兩組間不平衡的協變量經匹配後均達到平衡.匹配前,白蛋白正常組院內病死率為1.2％,低白蛋白組為5.7％,在校正瞭所有臨床因素後,Cox迴歸分析顯示,白蛋白每下降1 g/L,心衰患者的院內死亡風險增加12.0％(HR 1.120,95％ CI1.057～1.186;P＜0.001).匹配後,白蛋白正常組院內病死率為2.9％,低白蛋白組為5.7％,在校正瞭所有臨床因素後,Cox迴歸分析顯示,白蛋白每下降1 g/L,心衰患者的院內死亡風險仍增加11.0％(HR1.110,95％ CI1.043～1.181;P =0.001).結論 血清白蛋白本身對心衰患者的預後存在影響,是心衰患者院內死亡的獨立危險因素,糾正低白蛋白可以降低心衰患者的院內死亡風險.
목적 탐토혈청백단백대심력쇠갈(심쇠)환자원내사망적영향.방법 련속입선2 430례주원심쇠환자,안혈청백단백수평분위백단백정상조(혈청백단백≥35g/L)、저백단백조(혈청백단백＜ 35 g/L).이원내전인사망위주요종점,사용경향성평분필배법대량조환자진행필배,득도조간협변량균형적양본,통과다인소Cox회귀분별평개필배전후혈청백단백대원내사망적영향.결과 2 430례입선환자,년령(68±14)세,공631례존재저백단백,점26.0％.필배전,여백단백정상조상비,림상특정방면,저백단백조년령경대,뉴약심공능분급、원내병사솔경고,확장성심기병、판막병、라내지응용경다,고혈압자경소,입원수축압경저,입원심솔경쾌,병정경장;실험실검사방면,저백단백조직접담홍소、감성린산매、곡안선전태매、기항、뇨산、뇨소、B형리납태경고,혈홍단백、담고순、혈납、입원좌심실사혈분수경저.사용경향성평분필배법,량조공631대필배성공,량조간불평형적협변량경필배후균체도평형.필배전,백단백정상조원내병사솔위1.2％,저백단백조위5.7％,재교정료소유림상인소후,Cox회귀분석현시,백단백매하강1 g/L,심쇠환자적원내사망풍험증가12.0％(HR 1.120,95％ CI1.057～1.186;P＜0.001).필배후,백단백정상조원내병사솔위2.9％,저백단백조위5.7％,재교정료소유림상인소후,Cox회귀분석현시,백단백매하강1 g/L,심쇠환자적원내사망풍험잉증가11.0％(HR1.110,95％ CI1.043～1.181;P =0.001).결론 혈청백단백본신대심쇠환자적예후존재영향,시심쇠환자원내사망적독립위험인소,규정저백단백가이강저심쇠환자적원내사망풍험.
Objective To analyze the prognostic value of serum albumin for in-hospital mortality in patients with heart failure.Methods A total of 2 430 consecutive heart failure patients aged at (68 ± 14) years were enrolled in the study.Patients were divided into 2 groups according to serum albumin concentration on admission: the normoalbuminemia group (≥35 g/L) and the hypoalbuminemia group (＜ 35 g/L).Propensity score matching was conducted to reduce confounding bias between the groups.Cox proportional-hazards regression models were used to evaluate the prognostic value of serum albumin for inhospital mortality in patients with heart failure before and after matching.Results Compared with those in the normoalbuminemia group, subjects in the hypoalbuminemia group were older, and had higher NYHA functional status and higher in-hospital mortality.More patients were diagnosed with dilated cardiomyopathy and valvular heart disease, and fewer were with hypertension in the hypoalbuminemia group than those patients in the normoalbuminemia group.Moreover, patients in this group presented with faster heart rate and lower systolic blood pressure than those in the normoalbuminemia group.They had higher levels of direct bilirubin, alkaline phosphatase, glutamyltranspetidase, creatinine, uric acid, urea, and B-type natriuretic peptide (BNP) and lower levels of hemoglobin, total cholesterol (TC), and serum sodium compared with subjects in the normoalbuminemia group.Left ventricular ejection fractions (LVEF) of patients were lower in the hypoalbuminemia group than those of patients in the normoalbuminemia group.More patients were of long-duration and treated with spirolactone.With protensity score matching, 631 pairs of patients were successfully matched.Before matching, the in-hospital mortality in normoalbuminemia group was 1.2％ and that in hypoalbuminemia group was 5.7％.The multivariate Cox regression analysis indicated that the risk for in-hospital death in patients with heart failure was 12.0％ greater for each 1 g/L decrement in albumin level after adjusted for all clinical factors (HR 1.120, 95％ CI 1.057-1.l86;P ＜0.001).The same held after matching.The in-hospital mortality in normoalbuminemia group was 2.9％, and that in hypoalbuminemia group was 5.7％.The multivariate Cox regression analysis showed that the risk for inhospital death in patients with heart failure was 11.0％ greater for each 1 g/L decrement in albumin level after adjusted for all clinical factors (HR 1.110, 95％ CI 1.043-1.181;P =0.001).Conclusions Serum albuminis is an independent risk factor for in-hospital mortality in patients with heart failure.Treatment of hypoalbuminemia may lower the in-hospital mortality in patients with heart failure.
