Page 47 - 南京医科大学学报自然科学版

第43卷第12期 南京医科大学学报（自然科学版）
2023年12月 Journal of Nanjing Medical University（Natural Sciences） ·1663 ·

·临床研究·

射血分数减低型心力衰竭患者容量负荷评估及应用

何 英，廖深根，王骁智 ，李新立
*
南京医科大学第一附属医院心血管内科，江苏 南京 210029

［摘 要］ 目的：探讨射血分数减低型心力衰竭（heart failure with reduced ejection fraction，HFrEF）患者容量状态的评估及其对
预后评价的影响。方法：前瞻性连续纳入2017—2022年因诊断为HFrEF于南京医科大学第一附属医院心血管内科住院就诊
的患者。采用估计的全身血浆容量（plasma volume，PV）对患者进行容量负荷状态的评估，并依据三分位数法将患者分为低、
中、高容量负荷组。通过相关分析评估PV与经典的容量负荷标志物的相关性，Kaplan⁃Meier法绘制生存曲线，以及单因素及多
因素COX 回归分析射血分数减低型心力衰竭的容量负荷状态与预后的相关性。结果：研究共纳入233例患者，预估的PV为
（4.26±1.08）L。PV与脑钠肽前体（pro B⁃type natriuretic peptide，proBNP）具有明确相关性；中位随访25个月后，90例患者发生
心血管死亡和心衰恶化再入院，多因素校正年龄、收缩压、proBNP、肾功能、纽约心功能分级（NYHA分级）后，相对于容量负荷
低组，容量负荷中组和高组与心血管死亡和心衰恶化再入院的风险分别比为 1.78（0.94~3.36）和 2.74（1.45~5.16）。结论：
HFrEF患者高容量负荷状态是HFrEF患者预后的独立危险因素。
［关键词］ 射血分数减低型心力衰竭；容量负荷；评估；预后
［中图分类号］ R541.6 ［文献标志码］ A ［文章编号］ 1007⁃4368（2023）12⁃1663⁃05
doi：10.7655/NYDXBNS20231207

Evaluation and application of volume load in patients with heart failure with reduced

ejection fraction
*
HE Ying，LIAO Shengen，WANG Xiaozhi ，LI Xinli
Department of Cardiology，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China

［Abstract］ Objective：To evaluate the volume status and its impact on prognosis in heart failure patients with reduced ejection
fraction（HFrEF）. Methods：Prospective and consecutive patients hospitalized in Department of Cardiology of the First Affiliated
Hospital of Nanjing Medical hospital due to the diagnosis of HFrEF from 2017 to 2022 were enrolled. Estimated plasma volume（PV）

was used to assess the patient’s volume load status，and divide the patients into low，medium，and high⁃volume load groups based on
tertiles methods. Correlation analysis was used to evaluate the correlation between PV and classic volume load markers；Kaplan⁃Meier
method was used to plot survival curves，and both univariate and multivariable COX regression analysis were performed to evaluate the
correlation between volume load status and prognosis of HFrEF. Results：This study included 233 patients with an estimated PV of
（4.26 ± 1.08）L. There is a clear correlation between PV and pro B⁃type natriuretic peptide（proBNP）. After a median follow⁃up of 25
months，90 patients experienced cardiovascular death and worsening heart failure requiring readmission. After adjusting for multiple
factors including age，systolic blood pressure，proBNP，renal function，and New York Heart Association（NYHA）grading，compared to
the low⁃volume load group，the medium and high volume load groupshad a hazard ratio of 1.78（0.94⁃3.36）and 2.74（1.45⁃5.16），
respectively，for cardiovascular death and worsening heart failure. Conclusion：The assessment of volume load status in patients with
HFrEF shows that high⁃volume load is an independent risk factor for the prognosis of HFrEF patients.
［Key words］ heart failure with reduced ejection fraction；volume load；evaluation；prognosis
［J Nanjing Med Univ，2023，43（12）：1663⁃1667］

［基金项目］ 国家自然科学基金（81730106）
∗
通信作者（Corresponding author），E⁃mail：wangxz@njmu.edu.cn