目的:本研究旨在构建并验证能够预测射血分数保留型心力衰竭(heart failure with preserved ejection fraction,HFpEF)的患者预后的模型。方法:本研究为单中心回顾性队列研究,纳入了2019年1月1日至2021年1月1日期间,在郑州大学第一附属...目的:本研究旨在构建并验证能够预测射血分数保留型心力衰竭(heart failure with preserved ejection fraction,HFpEF)的患者预后的模型。方法:本研究为单中心回顾性队列研究,纳入了2019年1月1日至2021年1月1日期间,在郑州大学第一附属医院就诊的537例HFpEF患者,于12、24及36个月进行随访。结局事件为全因死亡和任何原因再住院。通过多因素COX回归分析,筛选出与HFpEF预后相关变量,基于这些变量构建列线图模型,并通过时间依赖的受试者工作特征曲线、校准曲线对模型的预测效能进行评估。结果:共纳入537例患者,有119例患者出现结局事件。筛选后,D-二聚体与白蛋白比值(D-dimer to albumin ratio,DAR)、高胆固醇血症、LDL-C、BMI、BNP和年龄被纳入列线图模型。在受试者工作曲线中,该模型在24个月内的曲线下面积(AUC)为0.750(95%CI:0.695~0.806),其一致性指数为0.764(95%CI:0.711~0.812),模型在36个月内的AUC为0.723(95%CI:0.669~0.780),在12个月内的AUC为0.700(95%CI:0.626~0.774),表现出稳定的预测效能。校准曲线和临床影响曲线显示模型预测结果与实际结果高度一致。结论:本研究基于DAR构建的列线图模型能够有效预测HFpEF患者在3年内的全因死亡和任何原因再住院风险,具有良好的预测效能和稳健性,能够准确地评估HFpEF患者的预后。展开更多
目的:探索沙库巴曲缬沙坦治疗射血分数保留的心力衰竭的安全性。方法:检索PubMed、Web of Science、Embase等数据库自建库至2024年4月,沙库巴曲缬沙坦治疗射血分数保留的心力衰竭的随机对照试验。由2名研究者独立筛选文献、提取资料并...目的:探索沙库巴曲缬沙坦治疗射血分数保留的心力衰竭的安全性。方法:检索PubMed、Web of Science、Embase等数据库自建库至2024年4月,沙库巴曲缬沙坦治疗射血分数保留的心力衰竭的随机对照试验。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险,采用RevMan5.3软件进行Meta分析。结果:与缬沙坦/依那普利/安慰剂相比,沙库巴曲缬沙坦可显著改善HFpEF患者的心力衰竭住院(RR=0.90,95%CI:0.84~0.96,P=0.001)和心力衰竭急性发作(RR=0.70,95%CI:0.53~0.94,P=0.02)的结果,发生肾损伤(RR=0.61,95%CI:0.41~0.92,P=0.02)、使肾小球滤过率下降>50%(RR=0.61,95%CI:0.41~0.92,P=0.02)和至少一次不良事件(RR=0.69,95%CI:0.48~0.97,P=0.03)的风险更低,但发生低血压(RR=1.58,95%CI:1.12~2.23,P=0.009)和血管性水肿(RR=2.22,95%CI:1.01~4.87,P=0.05)的风险更高。结论:沙库巴曲缬沙坦用于治疗射血分数保留的心力衰竭时,可更有效的减少心力衰竭住院及急性心力衰竭发作,且可减少肾损伤及不良事件的发生,但更易导致低血压及血管性水肿。展开更多
目的:探讨不同左室射血分数(LVEF)水平与心力衰竭人群肾功能障碍的关联。方法:以2006年至2018年期间参与开滦集团健康体检并于2020年12月31日前首次确诊心力衰竭的个体为研究对象,按照LVEF Objective: To investigate the association b...目的:探讨不同左室射血分数(LVEF)水平与心力衰竭人群肾功能障碍的关联。方法:以2006年至2018年期间参与开滦集团健康体检并于2020年12月31日前首次确诊心力衰竭的个体为研究对象,按照LVEF Objective: To investigate the association between different levels of left ventricular ejection fraction (LVEF) and renal dysfunction in patients with heart failure. Methods: Individuals who participated in the Kailuan Group health examinations between 2006 and 2018 and were first diagnosed with heart failure by December 31, 2020, were included as the study population. Participants were categorized into three groups based on LVEF levels: LVEF < 40%, 40% ≤ LVEF < 50%, and LVEF ≥ 50%. LVEF was used as the independent variable, and the presence of renal dysfunction was used as the dependent variable. A binary logistic regression model was constructed to calculate odds ratios (ORs) and their 95% confidence intervals (CIs). Subgroup analyses were performed according to age, sex, and obesity. Additionally, sensitivity analyses were conducted by excluding individuals with a history of hypertension, diabetes, myocardial infarction, or pre-existing chronic kidney disease (CKD) to verify the robustness of the results. Results: A total of 3272 participants were included in this study, of whom 2837 (86.7%) were male, with a mean age of 68.01 ± 10.99 years. Logistic regression analysis showed that, compared with the reference group (LVEF ≥ 50%), the odds ratios (ORs) for renal dysfunction were 1.73 (95% CI: 1.31~2.29) in the 40% ≤ LVEF < 50% group and 2.42 (95% CI: 1.72~3.41) in the LVEF < 40% group. Subgroup analysis revealed that, except for the female subgroup, which showed no statistically significant difference, the results were consistent with the overall analysis across all other subgroups. Conclusion: The risk of renal dysfunction increases progressively with the decline in LVEF among patients with heart failure.展开更多
文摘目的:本研究旨在构建并验证能够预测射血分数保留型心力衰竭(heart failure with preserved ejection fraction,HFpEF)的患者预后的模型。方法:本研究为单中心回顾性队列研究,纳入了2019年1月1日至2021年1月1日期间,在郑州大学第一附属医院就诊的537例HFpEF患者,于12、24及36个月进行随访。结局事件为全因死亡和任何原因再住院。通过多因素COX回归分析,筛选出与HFpEF预后相关变量,基于这些变量构建列线图模型,并通过时间依赖的受试者工作特征曲线、校准曲线对模型的预测效能进行评估。结果:共纳入537例患者,有119例患者出现结局事件。筛选后,D-二聚体与白蛋白比值(D-dimer to albumin ratio,DAR)、高胆固醇血症、LDL-C、BMI、BNP和年龄被纳入列线图模型。在受试者工作曲线中,该模型在24个月内的曲线下面积(AUC)为0.750(95%CI:0.695~0.806),其一致性指数为0.764(95%CI:0.711~0.812),模型在36个月内的AUC为0.723(95%CI:0.669~0.780),在12个月内的AUC为0.700(95%CI:0.626~0.774),表现出稳定的预测效能。校准曲线和临床影响曲线显示模型预测结果与实际结果高度一致。结论:本研究基于DAR构建的列线图模型能够有效预测HFpEF患者在3年内的全因死亡和任何原因再住院风险,具有良好的预测效能和稳健性,能够准确地评估HFpEF患者的预后。
文摘目的:探索沙库巴曲缬沙坦治疗射血分数保留的心力衰竭的安全性。方法:检索PubMed、Web of Science、Embase等数据库自建库至2024年4月,沙库巴曲缬沙坦治疗射血分数保留的心力衰竭的随机对照试验。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险,采用RevMan5.3软件进行Meta分析。结果:与缬沙坦/依那普利/安慰剂相比,沙库巴曲缬沙坦可显著改善HFpEF患者的心力衰竭住院(RR=0.90,95%CI:0.84~0.96,P=0.001)和心力衰竭急性发作(RR=0.70,95%CI:0.53~0.94,P=0.02)的结果,发生肾损伤(RR=0.61,95%CI:0.41~0.92,P=0.02)、使肾小球滤过率下降>50%(RR=0.61,95%CI:0.41~0.92,P=0.02)和至少一次不良事件(RR=0.69,95%CI:0.48~0.97,P=0.03)的风险更低,但发生低血压(RR=1.58,95%CI:1.12~2.23,P=0.009)和血管性水肿(RR=2.22,95%CI:1.01~4.87,P=0.05)的风险更高。结论:沙库巴曲缬沙坦用于治疗射血分数保留的心力衰竭时,可更有效的减少心力衰竭住院及急性心力衰竭发作,且可减少肾损伤及不良事件的发生,但更易导致低血压及血管性水肿。
文摘目的:探讨不同左室射血分数(LVEF)水平与心力衰竭人群肾功能障碍的关联。方法:以2006年至2018年期间参与开滦集团健康体检并于2020年12月31日前首次确诊心力衰竭的个体为研究对象,按照LVEF Objective: To investigate the association between different levels of left ventricular ejection fraction (LVEF) and renal dysfunction in patients with heart failure. Methods: Individuals who participated in the Kailuan Group health examinations between 2006 and 2018 and were first diagnosed with heart failure by December 31, 2020, were included as the study population. Participants were categorized into three groups based on LVEF levels: LVEF < 40%, 40% ≤ LVEF < 50%, and LVEF ≥ 50%. LVEF was used as the independent variable, and the presence of renal dysfunction was used as the dependent variable. A binary logistic regression model was constructed to calculate odds ratios (ORs) and their 95% confidence intervals (CIs). Subgroup analyses were performed according to age, sex, and obesity. Additionally, sensitivity analyses were conducted by excluding individuals with a history of hypertension, diabetes, myocardial infarction, or pre-existing chronic kidney disease (CKD) to verify the robustness of the results. Results: A total of 3272 participants were included in this study, of whom 2837 (86.7%) were male, with a mean age of 68.01 ± 10.99 years. Logistic regression analysis showed that, compared with the reference group (LVEF ≥ 50%), the odds ratios (ORs) for renal dysfunction were 1.73 (95% CI: 1.31~2.29) in the 40% ≤ LVEF < 50% group and 2.42 (95% CI: 1.72~3.41) in the LVEF < 40% group. Subgroup analysis revealed that, except for the female subgroup, which showed no statistically significant difference, the results were consistent with the overall analysis across all other subgroups. Conclusion: The risk of renal dysfunction increases progressively with the decline in LVEF among patients with heart failure.
