| Objective:To investigate the body water and nutritional status in patients of heart failure with different hospitalization times.Objects and methods:1. Objects:107 patients with chronic heart failure who were hospitalized in the fourth ward of Hebei People's Hospital from January 2018 to September2019 were selected.According to the times of hospitalization,the patients with heart failure were divided into the first hospitalization group(47 cases),the 2-4 hospitalization group(30 cases),and the?5 hospitalization group(30cases).2.Method:The application of body composition analyzer(INBODY S10from Korea)was determined in heart failure patients of extracellular water(ECW),intracellular water(ICW),total body water(TBW)and the body and body segments water ratio(ECW%,swelling index,extracellular water/total body water),quality of protein,quality of skeletal muscle,skeletal muscle mass(SMM),body fat rate,Fat-free mass(FFM),and calculate intracellular water/total body water(ICW%)and total body water/body quality(TBW%)within 24 hours.The fasting venous blood was collected next morning,White blood cell(WBC),Hemoglobin(Hb),Red blood count(RBC),Hematokrit(HTC),platelets(PLT)and other indicators were detected by routine blood analyzer,albumin(ALB),the alanine aminotransferase(ALT),aspartate transaminase(AST),creatinine(Cr),serum potassium,serum sodium,total cholesterol(TC),total triglyceride(TG),high density lipoprotein(HDL),low density lipoprotein(LDL)and other indicators were detected by automatic biochemical analyzer;Cardiac ultrasound was used to measure left atrium diameter(LAD),left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic dimension(LVEDD),and to compare the differences among the above indicators in patients of heart failure with different hospitalization times.Results:1. Comparison of general data in three groups of patients with heart failure107 patients who met the diagnostic criteria for heart failure were selected and divided into the first hospitalization group which included 47patients(mean age 66.94±12.44 years old,31 males),the 2-4 hospitalization group which included 30 patients(mean age 71.87±13.36 years old,19 males),the?5 hospitalization group which included 30 patients(mean age 73.33±9.82years old,14 males),and the three groups with no statistical significance in age and gender.With the increase of hospitalization times,ALB,serum sodium,TC,LDL gradually decreased,NT-pro BNP gradually increased,the difference was statistically significant.ALB(g/L)vs.36.8(34.2,39.6)vs.36.4(32.5,39.2),P<0.05;Serum sodium(mmol/L)141(139,143)vs.140(138,141)vs.138(135,141),P<0.05;TC(mmol/L)4.15(3.52,5.21)vs.3.58(3.00,4.72)vs.3.81(2.77,4.05),P<0.05;LDL(mmol/L)2.76(2.06,3.47)vs.2.37(1.82,3.03)vs.2.45(1.66,2.79),P<0.05;NT-pro BNP(ng/L)3185±1952 vs.4625±2853 vs.4862±2878,P<0.05.The difference between the first hospitalization group and the?5 hospitalization group was statistically significant(P<0.05),and the difference between them was not statistically significant(P>0.05).Hospitalization times were positively correlated with NT-pro BNP(r_s=0.252,P<0.05),and negatively correlated with ALB,serum sodium,TC,and LDL(r_s=-0.240,-0.314,-0.296,-0.287,P<0.05).There were no significant differences in WBC,RBC,Hb,HCT,PLT,AST,ALT,potassium,Cr,TG,HDL among the three groups(P>0.05).2. Comparison of body water in three groups of patients with heart failureWith the increase of hospitalization frequency,ICW%of patients in the three groups decreased gradually,while ECW%(whole body,trunk and lower limbs)increased gradually,and the differences were statistically significant.ICW%60.79(60.24,61.62)vs.60.28(59.37,60.91)vs.59.27(58.19,60.26),P<0.01;Whole body ECW%39.11±1.10 vs.39.74±1.04 vs.40.75±1.47,P<0.01;Left upper limb ECW%38.20(37.80,38.90)vs.38.55(38.18,39.63)vs.38.90(38.40,39.63),P<0.01;Right upper limb ECW%38.10(37.50,38.70)vs.38.45(37.90,39.20)vs.38.85(38.18,39.40),P<0.01;Trunk ECW%39.22±1.11 vs.40.03±1.17 vs.40.83±1.52,P<0.01;Left lower limb ECW%39.34±1.28 vs.40.40±1.38 vs.41.16±1.65,P<0.01;Right lower limb ECW%39.50(38.40,40.60)vs.39.85(39.35,41.03)vs.41.05(40.18,42.43),P<0.01.Among the pairwise comparisons,ICW%,left upper limb ECW%and right upper limb ECW%were statistically significant between the first hospitalization group and the?5 hospitalization group(P<0.01),while there were no statistically significant differences between the first hospitalization group and the 2-4 hospitalization group,the 2-4hospitalization group and the?5 hospitalization group(P>0.05).There were statistically significant differences in total ECW%,trunk ECW%and left lower limb ECW%between the three groups(P<0.01).Right lower limb ECW%was statistically significant between the first hospitalization group and the?5 hospitalization group,the 2-4 hospitalization group and the?5hospitalization group,while there was no statistically significant difference between the first hospitalization group and the 2-4 hospitalization group(P>0.05).Hospitalization frequency was positively correlated with systemic ECW%(r_s=0.458,P<0.01)and negatively correlated with ICW%(r_s=-0.468,P<0.01).There were no significant differences in ICW,ECW,TBW and TBW%between three groups(P>0.05).3.Comparison of nutritional indicators in three groups of patients with heart failureWith the increase of hospitalization times,fat-free mass,protein quality,skeletal muscle mass,muscle mass(whole body,trunk,upper limbs,lower limbs)and upper arm muscle circumference gradually decreased.Fat-free mass(kg)50.50(43.50,64.10)vs.45.85(40.38,58.55)vs.46.70(40.13,52.50),P<0.05;Protein quality(kg)10.41±2.62 vs.9.45±2.79 vs.8.62±1.58,P<0.05;Skeletal muscle mass(kg)27.80(23.2,36.2)vs.25.35(21.17,31.95)vs.24.95(20.91,27.17),P<0.05;Systemic muscle mass(kg)47.80(40.90,60.20)vs.43.30(38.33,54.40)vs.44.15(37.40,49.30),P<0.05;Left upper limb muscle mass(kg)2.83(2.23,3.38)vs.2.72(2.03,3.39)vs.2.25(1.90,2.74),P<0.05;Right upper limb segments muscle mass(kg)2.77(2.22,3.20)vs.2.48(1.88,3.25)vs.2.28(1.95,2.70),P<0.05;Right lower limb muscle mass(kg)23.10(19.40,25.80)vs.21.85(17.50,24.45)vs.19.80(17.00,21.38),P<0.05;The left leg muscle mass(kg)8.32(6.66,11.11)vs.7.13(5.93,9.97)vs.7.62(5.56,8.73),P<0.05;Right lower limb muscle mass(kg)8.60±2.52 vs.7.80±2.39 vs.7.04±1.79,P<0.05;Upper arm muscle circumference(cm)25.50(23.20,27.90)vs.25.50(22.37,27.67)vs.23.05(22.15,25.10),P<0.05.In the pairwise comparison among the three groups,the differences between the first hospitalization group and the?5 hospitalization group were statistically significant,while the differences between the first hospitalization fat-free mass and the 2-4 hospitalization group,the 2-4 hospitalization group and the?5hospitalization group were not statistically significant.The hospitalization frequency was negatively correlated with fat-free mass,protein quality,skeletal muscle mass,and muscle mass(r_s=-0.257,-0.290,-0.286,-0.261,P<0.01).There were no statistically significant differences in body fat,body fat percentage and BMI among the three groups(P>0.05).Conclusion:1.Hearth failure patients with abnormal distribution of moisture,fluid retention in the extracellular fluid,as extracellular fluid ratio increased,while Intracellular fluid ratio decreased.The degree of limb edema was higher in patients admitted to hospital repeatedly than in patients admitted to hospital for the first time,especially,in the lower extremity edema.With the prolonged course of heart failure,the risk of fluid retention in patients with heart failure increased,and the prognosis became worse.2.As the number of hospitalizations for heart failure increased,the risk of malnutrition increased fat-free mass,protein quality,skeletal muscle mass and other indicators showed a downward trend.3. Patients with heart failure showed a decreasing trend of TC and LDL with the increase of hospitalization frequency,and there were no statistically significant differences in body fat,TG and HDL in patients of heart failure with different hospitalization times. |
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