Page 87 - 2023-03-中国全科医学

·336· http: //www.chinagp.net E-mail: zgqkyx@chinagp.net.cn Jaunary 2023, Vol.26 No.3

investigate the association of nutritional status with prognosis in elderly patients with HF with preserved ejection fraction（HFpEF）
and coronary heart disease. Methods A retrospective cohort study was conducted. Inpatients with HFpEF and coronary heart
disease （ ≥ 60 years old，NYHA grade Ⅱ - Ⅳ ） treated in Department of Geriatrics，Beijing Tongren Hospital，Capital
Medical University between 2017 and 2019 were enrolled. Clinical and laboratory data were collected. HF-related readmission
and all-cause mortality within one year after discharge were followed up. Nutritional status was evaluated by controlling nutritional
status （CONUT） score，geriatric nutritional risk index （GNRI） and prognostic nutritional index （PNI）. Patients were
divided into non-malnutrition group （CONUT score 0-1，n=42），low malnutrition risk group （CONUT score 2-4，n=181）
and medium-high malnutrition risk group （CONUT score 5-12，n=156）. The differences in clinical data and prognosis among
the three groups were compared. Univariate and multivariate logistic regression analyses were used to explore the influencing
factors of readmission due to HF and all-cause mortality within one year after discharge. ROC analysis was used to analyze the
prognostic value of CONUT score，GNRI and PNI for readmission due to HF and all-cause mortality within 1 year after discharge.
Results Age，proportion of elderly patients，sex，BMI，bed rest，length of hospital stay，NYHA grade，hemoglobin，
lymphocytes，urea nitrogen，creatinine，total protein，albumin，triacylglycerol，total cholesterol，low density lipoprotein
cholesterol，B-type brain natriuretic peptide （BNP），all-cause death within 1 year were compared among the three groups，
and there were statistically significant differences（P<0.05）；among them，age，proportion of elderly patients，bed rest，
length of hospital stay，NYHA grade，old myocardial infarction，urea nitrogen，creatinine，BNP，and all-cause death within
1 year in the no-malnutrition risk group and the low-malnutrition risk group were significantly lower than those in the medium-
high malnutrition risk group（P<0.05），and BMI，hemoglobin，lymphocytes，total protein，albumin，triacylglycerol，total
cholesterol and low-density lipoprotein cholesterol were significantly higher than those in the medium-high malnutrition risk group
（P<0.05）. Univariate logistic regression analysis showed that age，bed rest，length of stay，NYHA grade，hemoglobin，
albumin，BNP， left ventricular ejection fraction，CONUT score，GNRI and PNI are the influencing factors of readmission
due to HF and all-cause death within 1 year （P<0.05）. Multivariate logistic regression analysis showed that CONUT score
〔OR=1.567，95%CI （1.302，1.885），P<0.05〕 is an influence factor of all-cause death within 1 year （P<0.05）. ROC
analysis estimating the performance in predicting all-cause mortality within one year after discharge showed that the AUC of
CONUT score was 0.780〔95%CI（0.714，0.845）〕 with 0.723 sensitivity and 0.722 specificity when the optimal cut-off value
was determined as 7.5，the AUC of GNRI was 0.695〔95%CI（0.604，0.786）〕with 0.532 sensitivity and 0.833 specificity
when the optimal cut-off value was determined as 89，and the AUC of PNI was 0.722〔95%CI（0.643，0.800）〕 with 0.723
sensitivity and 0.654 specificity when the optimal cut-off value was determined as 41. Conclusion CONUT score can be used as
the preferred nutritional evaluation tool for mortality risk assessment in elderly patients with HFpEF and coronary heart disease，
and nutritional intervention may become one of the therapeutic targets for reducing mortality in the future.
【Key words】 Heart failure；Heart failure with preserved ejection fraction；Coronary disease；Controlling nutritional
status score；Prognosis；Elderly

全球人口老龄化加剧，我国人口老龄化进程也逐渐 病种复杂、病程长等多种因素影响，我国老年人群营养
加快，预计到 2050 年，我国超 60 岁的老年人将增至 4.78 风险整体较高，且我国约有 48.4% 的老年人营养状态不
亿（占总人口的 35.10%） ［1］ 。老年人冠心病多发，长 佳。数项评估患者营养状态的研究表明，营养状态不良
期的心肌缺血、心肌梗死等可导致心肌纤维性重构，心 的老年患者在感染发生率、病死率、住院时间及医疗费
腔扩大，心肌收缩力下降，射血功能受损，心排血量不 用方面均较营养状态正常的老年患者高 ［3-4］ 。但是，上
能满足机体代谢的需要，器官、组织血液灌注不足，同 述研究多集中于伴糖尿病、肺部感染、肿瘤或处于围术
时出现肺循环和/或体循环淤血，表现为心力衰竭（HF）。 期的患者，缺乏对老年 HF 患者营养状态的研究，本文
HF 也是各种心脏疾病的终末阶段，其导致了心血管疾 便以此为切入点，尝试分析营养状态与老年 HF 患者预
病相关患者的再住院率及死亡率居高不下，已成为全球 后的关系。
性重大公共卫生问题。随着我国人口老龄化的加剧，合 由 于 射 血 分 数 保 留 心 力 衰 竭（heart failure with
并冠心病的老年 HF 患者数量将进一步增加，严重影响 preserved ejection fraction，HFpEF） 比 射 血 分 数 减 低
我国中老年人的身心健康。营养状况受多方面影响，营 心 力 衰 竭（heart failure with reduced ejection fraction，
养状态不佳会加重患者疾病的严重程度。《中国老年人 HFrEF）在临床上要更为常见，因此，本文以合并冠心
营养与健康报告》 ［2］ 指出，由于受生理功能减退、失能、 病的老年 HFpEF 患者为研究对象，以临床常用于评估