van Veldhuisen D J, Boomsma F, de Kam P J, Man in't Veld A J, Crijns H J, Hampton J R, Lie K I
Department of Cardiology/Thoraxcenter, University Hospital, Groningen, The Netherlands.
Eur Heart J. 1998 May;19(5):753-60. doi: 10.1053/euhj.1997.0840.
Heart failure is a major medical problem in the elderly. Neurohormonal activation plays a role in the pathophysiology of heart failure, but is also affected by ageing. The present study was carried out to examine the influence of age on neurohormonal activation and prognosis in patients with chronic heart failure.
We studied 372 patients with moderate to severe chronic heart failure (New York Heart Association [NYHA] functional class III-IV), who were treated with angiotensin converting enzyme (ACE) inhibitors (95%), diuretics (99%), and digoxin (59%). Their mean age was 68 +/- 8 years (range 38-80), left ventricular ejection fraction 0.23 +/- 0.08, and 77% were males. The relationship between age and plasma neurohormones (norepineprine, epinephrine, dopamine, renin, aldosterone, atrial natriuretic peptide, N-terminal atrial natriuretic peptide, and endothelin), and age and prognosis was examined. Only atrial natriuretic peptide and N-terminal atrial natriuretic peptide showed an independent, positive correlation with age (P < 0.0001). On univariate analysis, norepinephrine also increased, while renin and aldosterone decreased (all P < 0.05). As regards mortality (25%), there was no linear increase with ageing for the group as a whole during follow-up, but patients in the highest age quartile (> 74 years) had a significantly higher mortality (risk ratio 1.9) than younger patients (P < 0.05).
Although several plasma neurohormones are affected by ageing on univariate analysis, only atrial natriuretic peptide and N-terminal atrial natriuretic peptide show a highly significant increase with ageing on multivariate analysis. There is no linear increase in mortality with ageing, but in the truly elderly heart failure patients (> 74 years), age alone was an independent predictor for mortality.
心力衰竭是老年人面临的一个主要医学问题。神经激素激活在心力衰竭的病理生理学中起作用，但也受衰老影响。本研究旨在探讨年龄对慢性心力衰竭患者神经激素激活及预后的影响。
我们研究了372例中重度慢性心力衰竭患者（纽约心脏协会[NYHA]心功能分级III - IV级），这些患者接受了血管紧张素转换酶（ACE）抑制剂（95%）、利尿剂（99%）和地高辛（59%）治疗。他们的平均年龄为68±8岁（范围38 - 80岁），左心室射血分数为0.23±0.08，77%为男性。研究了年龄与血浆神经激素（去甲肾上腺素、肾上腺素、多巴胺、肾素、醛固酮、心房利钠肽、N末端心房利钠肽和内皮素）之间的关系，以及年龄与预后的关系。仅心房利钠肽和N末端心房利钠肽与年龄呈独立正相关（P < 0.0001）。单因素分析显示，去甲肾上腺素也升高，而肾素和醛固酮降低（均P < 0.05）。关于死亡率（25%），在随访期间整个组并未随年龄呈线性增加，但年龄最高四分位数（> 74岁）的患者死亡率显著高于年轻患者（风险比1.9）（P < 0.05）。
尽管单因素分析显示几种血浆神经激素受衰老影响，但多因素分析显示仅心房利钠肽和N末端心房利钠肽随衰老显著升高。死亡率并未随年龄呈线性增加，但在真正的老年心力衰竭患者（> 74岁）中，年龄本身就是死亡率的独立预测因素。
