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预后营养指数与急性心力衰竭患者预后的相关性分析

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刘春蕊, 杨一鸣, 赵燕茹, 等. 预后营养指数与急性心力衰竭患者预后的相关性分析[J]. 临床急诊杂志, 2023, 24(1): 1-5. doi: 10.13201/j.issn.1009-5918.2023.01.001
引用本文: 刘春蕊, 杨一鸣, 赵燕茹, 等. 预后营养指数与急性心力衰竭患者预后的相关性分析[J]. 临床急诊杂志, 2023, 24(1): 1-5. doi: 10.13201/j.issn.1009-5918.2023.01.001
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LIU Chunrui, YANG Yiming, ZHAO Yanru, et al. Correlation analysis of prognostic nutritional index and prognosis in patients with acute heart failure[J]. J Clin Emerg, 2023, 24(1): 1-5. doi: 10.13201/j.issn.1009-5918.2023.01.001
Citation: LIU Chunrui, YANG Yiming, ZHAO Yanru, et al. Correlation analysis of prognostic nutritional index and prognosis in patients with acute heart failure[J]. J Clin Emerg, 2023, 24(1): 1-5. doi: 10.13201/j.issn.1009-5918.2023.01.001
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预后营养指数与急性心力衰竭患者预后的相关性分析

    • 徐州医科大学附属医院心内科(江苏徐州，221000)

  • 基金项目:
    国家自然科学基金项目(No：81400178)
详细信息

Correlation analysis of prognostic nutritional index and prognosis in patients with acute heart failure

    • Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, China

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    摘要
  • 目的 探讨预后营养指数(PNI)对急性心力衰竭(AHF)患者预后的影响。方法 回顾性分析124例因AHF入住我院的患者临床资料，进行为期1年的随访。定义终点事件为全因死亡或心衰再住院治疗，根据患者检验结果计算PNI，分析其对AHF患者预后的影响。结果 1年内预后良好组和预后不良组的PNI水平差异有统计学意义(P < 0.05)。ROC曲线显示：曲线下面积(AUC)为0.747，PNI最佳截断值为46.35(95%CI：0.661~0.833)，灵敏度为76.0%，特异度为66.2%。PNI≤46.35的营养不良组患者出现预后不良的风险是营养良好患者的3.44倍(95%CI：1.276~9.273，P=0.015)。此外，N末端脑钠肽前体(NT-proBNP)、左心室射血分数(LVEF)均是影响AHF患者1年预后的独立危险因素(P < 0.05)。结论 入院时低PNI评分与AHF患者的不良预后相关，PNI用于评估AHF患者预后具有一定的临床价值。
    Objective To investigate the effect of prognostic nutritional index (PNI) on prognosis of patients with acute heart failure (AHF).Methods The clinical data of 124 patients admitted to our hospital due to acute heart failure were retrospectively analyzed and followed up for 1 year. The endpoint event was defined as all-cause death or rehospitalization for heart failure, and PNI was calculated based on patient test results to analyze its effect on prognosis in patients with acute heart failure.Results There was significant difference in PNI levels between the good prognosis group and the poor prognosis group within 1 year (P < 0.05). The ROC curve showed that the area under the curve (AUC) was 0.747, the optimal cut-off value of PNI was 46.35 (95%CI: 0.661-0.833), the sensitivity was 76.0%, and the specificity was 66.2%. Patients in the malnourished group with PNI≤46.35 had a 3.44-fold higher risk of poor outcome than those in the well-nourished group (95%CI: 1.276-9.273 P=0.015). In addition, N-terminal brain natriuretic peptide precursor (NT-proBNP) and left ventricular ejection fraction (LVEF) were independent risk factors for 1-year prognosis in patients with acute heart failure (P < 0.05).Conclusion Low PNI score on admission is associated with poor prognosis in patients with acute heart failure, and PNI has certain clinical value in evaluating the prognosis of patients with acute heart failure.
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  • 图 1  PNI的ROC曲线

    下载: 全尺寸图片 幻灯片

    图 2  不同PNI分组的AHF患者生存曲线

    下载: 全尺寸图片 幻灯片

    表 1  不同预后及营养状态的AHF患者的基线临床特征 例(%)，X±S，M(Q1，Q3)

    变量 总体(n=124) 预后 营养状态
    良好(n=74) 不良(n=50) t/χ2 P 高PNI (n=61) 低PNI (n=63) t/χ2 P
    年龄/岁 71(64，79) 70(58，77) 78(67，83) 3.334 0.001 68(56，75) 77(68，82) 3.561 ＜0.001
    女性 60(48.3) 35(47.3) 25(50.0) 0.087 0.768 26(42.6) 34(54) 1.600 0.206
    住院时间/d 8.34±3.69 7.61±3.21 9.42±4.10 2.750 0.007 7.48±2.71 9.17±4.30 2.620 0.010
    AHF类型 2.223 0.176 0.106 0.745
      新发心衰 47(37.9) 32(43.2) 15(30.0) 24(39.3) 23(36.5)
      心衰急性加重 77(62.1) 42(56.8) 35(70.0) 37(60.7) 40(63.5)
    心衰合并症
      高血压 75(60.5) 42(56.8) 33(66.0) 1.067 0.302 39(63.9) 36(57.1) 0.598 0.439
      糖尿病 33(26.6) 19(25.7) 14(28.0) 0.083 0.774 24(39.3) 9(14.3) 9.964 0.002
      缺血性心肌病 49(39.5) 24(32.4) 25(50.0) 3.853 0.050 20(32.8) 29(46) 2.275 0.131
    NYHA分级 3.338 0.197 0.337 0.828
      Ⅱ级 30(24.2) 20(27.0) 10(20.0) 16(26.2) 14(22.2)
      Ⅲ级 58(46.8) 37(50.0) 21(42.0) 27(44.3) 31(49.2)
      Ⅳ级 36(29.0) 17(23.0) 19(38.0) 18(29.5) 18(28.6)
    实验室检查
      Hb/(g·L-1) 129.0±22.1 135.0±20.4 120.0±21.7 3.930 0.001 135.1±21.5 122.9±21.2 3.169 0.002
      淋巴细胞数/(×109·L-1) 1.40±0.53 1.54±0.49 1.19±0.52 3.730 0.001 1.70±0.48 1.11±0.39 7.553 < 0.001
      白蛋白/(g·L-1) 39.1±4.5 40.6±4.2 37.0±4.2 4.150 0.001 42.4±2.8 35.8±3.3 11.890 < 0.001
      胆固醇/(mmol·L-1) 3.91±1.01 3.95±0.96 3.84±1.08 0.639 0.524 3.90±1.0 3.91±1.01 0.083 0.934
      AST/(U·L-1) 26.0 (18.0，41.8) 27.5 (19.0，45.8) 22.0 (14.0，33.0) 2.010 0.045 30 (19，34.5) 24 (15，33) 1.790 0.073
      ALT/(U·L-1) 24.5 (19.0，34.0) 24.5 (19.0，36.3) 24.5 (17.0，21.0) 0.970 0.334 25 (19，34.5) 24 (19，33) 0.620 0.535
      肌酐/(μmol·L-1) 76.0 (65.0，94.8) 73 (59.8，89.0) 105.0 (82.0，139.2) 2.091 0.036 75 (61，89) 79 (66，103) 1.400 0.162
      尿素氮/(mmol·L-1) 6.8 (5.3，8.9) 8.1 (6.3，10.6) 7.3 (6.4，10.1) 2.832 0.050 6.7 (4.8，8.6) 6.8 (5.5，9.8) 0.977 0.328
      NT-proBNP/(pg·mL-1) 4121 (1999，8116) 2751 (1618，6136) 7769 (3901，14 382) 5.140 < 0.001 3121 (1849，6255) 2912 (1849，9813) 3.054 0.002
      LVEF/% 29.6±10.7 31.3±11.2 27.1±9.4 2.210 0.029 30.3±12.1 38.9±9.2 0.760 0.452
    临床用药情况
      利尿剂 116(93.5) 67(90.5) 49(98.0) 2.751 0.097 54(88.5) 62(98.4) 5.021 0.025
      ACER/ARB 31(25.0) 20(27.0) 11(22.0) 0.402 0.526 17(27.9) 14(22.2) 0.527 0.468
      β受体阻滞剂 92(74.2) 59(79.7) 33(66.0) 2.938 0.087 46(75.4) 46(73.0) 0.093 0.761
      ARNI 88(71.0) 52(70.3) 11(22.0) 0.043 0.835 42(68.9) 46(73.0) 0.261 0.610
      左西孟旦 20(16.1) 9(12.2) 33(66.0) 2.135 0.144 7(11.5) 13(20.6) 1.922 0.166
      他汀药物 82(66.1) 49(66.2) 33(66.0) 0.001 0.980 39(63.9) 43(68.3) 0.258 0.611
      阿司匹林 60(48.4) 37(50.0) 23(46.0) 0.191 0.662 31(50.8) 29(46) 0.284 0.594
    PNI 46.3 (42.0，50.4) 48.1 (44.3，52.0) 43.5 (40.0，46.5) 4.503 < 0.001
      高PNI 61(49.2) 49(66.2) 12(24.0) 21.280 < 0.001
      低PNI 63(50.8) 25(33.8) 38(76.0)
    预后不良 12(19.7) 38(60.3) 21.280 < 0.001
    注：Hb，血红蛋白浓度；ALT，丙氨酸氨基转移酶；AST，天门冬氨酸氨基转移酶；NT-proBNP，N末端脑钠肽前体；LVEF，左心室射血分数；NYHA，纽约心脏协会；ACEI，血管紧张素转化酶抑制剂；ARB，血管紧张素Ⅱ受体阻滞剂；ARNI，沙库巴曲缬沙坦；PNI，预后营养指数。
    下载: 导出CSV

    表 2  影响AHF患者预后的单因素和多因素分析(n=124)

    变量 单因素 多因素
    HR(95%CI) P HR(95%CI) P
    高PNI 1 1
    低PNI 6.207(2.766~13.928) ＜0.001 3.440(1.276~9.273) 0.015
    年龄 1.054(1.018~1.091) 0.003 1.005(0.959~1.053) 0.834
    Hb 0.966(0.947~0.985) ＜0.001 0.982(0.956~1.007) 0.162
    AST 0.976(0.956~0.996) 0.018 0.978(0.954~1.003) 0.081
    肌酐 1.013(1.000~1.026) 0.044 0.990(0.962~1.020) 0.514
    LVEF 0.961(0.927~0.997) 0.032 0.951(0.909~0.996) 0.034
    尿素氮 1.144(1.019~1.285) 0.023 1.133(0.894~1.437) 0.301
    住院天数 1.151(1.034~1.280) 0.010 1.045(0.901~1.211) 0.562
    NT-proBNP 1.000(1.000~1.000) ＜0.001 1.000(1.000~1.000) 0.005
    下载: 导出CSV
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收稿日期:  2022-10-25
刊出日期:  2023-01-10

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