Abstract: Background　There is no significant difference in short-term prognosis between acute heart failure（AHF）patients with reduced ejection fraction（AHFrEF）and AHF patients with preserved ejection fraction（AHFpEF）,but there have been few long-term follow-up data.Objective　To compare the three-year re-hospitalization rate and mortality after discharge between AHFrEF and AHFpEF,and to explore the influencing factors for re-hospitalization.Methods　A total of 296 patients who were first diagnosed with AHF in Department of Emergency of the Affiliated Hospital of Inner Mongolia Medical University and Inner Mongolia People’s Hospital during 2011 to 2012,were selected as study subjects.Subjects were divided into two groups according to the left ventricular ejection fraction（LVEF），AHFrEF group（LVEF <50%,n=171）and AHFpEF group（LVEF≥50%,n=125）.The patients’ gender,age,smoking history,combined disease,acute coronary syndrome（ACS）,congestive heart failure（CHF）,imaging examination,BNP level,and medication status after discharge were recorded.After discharge,patients were followed up for 3 years through telephone or clinic,the end point was re-hospitalization due to cardiocerebral vascular factors or death.Results　There were significant difference in detection rate of hypertension,COPD,ACS,CHF,left ventricular hypertrophy,and ratio of BNP≥220 ng/L,taking oral β receptor blockers（β-RB）between two groups（P<0.05）.There were no significant difference in rate of re-hospitalization due to ACS,stroke and malignant arrhythmia between two groups（P>0.05）.The rate of re-hospitalization due to heart failure and total re-hospitalization rate among AHFrEF group were significant higher than those among AHFpEF group（P<0.05）.According to multiariable Cox proportional hazards regression model,hypertension 〔HR=1.450,95%CI（1.036,2.030）〕 and BNP≥220 ng/L 〔HR=1.894,95%CI（1.327,2.702）〕 were independent risk factors for re-hospitalization of AHF patients（P<0.05）.One-year,two-year,and three-year survival rates among AHFrEF group were 98%，95% and 85%,respectively.One-year,two-year,and three-year survival rates among AHFpEF group were 98%，94% and 86%,respectively.There was significant difference in survival curve between two groups（χ2=6.656，P=0.010）.Conclusion　The rate of re-hospitalization due to heart failure in three years among AHFrEF patients is higher than that among AHFpEF patients,and survival rate in three years among AHFrEF patients is lower than that among AHFpEF patients.Hypertension and high level of BNP were independent risk factors for re-hospitalization of AHF patients.The follow-up of AHFrEF patients should be strengthened，and blood pressure in patients with hypertension should be controlled well.

Key words: Heart failure, Stroke volume, Hospitalization, Prognosis, Hypertension, Natriuretic peptide,brain

摘要： 背景　射血分数降低的急性心力衰竭（AHFrEF）和射血分数保留的急性心力衰竭（AHFpEF）患者短期预后差异不显著，但远期随访资料缺乏。目的　比较AHFrEF和AHFpEF患者出院后3年内再住院率和病死率，并探讨影响患者再住院的危险因素。方法　选取2011—2012年于内蒙古医科大学附属医院急诊科和内蒙古自治区人民医院急诊科首次诊断为急性心力衰竭（AHF）的患者296例为研究对象，依据左心室射血分数（LVEF），将患者分为AHFrEF组（LVEF<50%，n=171）和AHFpEF组（LVEF≥50%,n=125）。记录患者性别、年龄、吸烟史、合并症、急性冠脉综合征（ACS）、充血性心力衰竭（CHF）、影像学检查、B型利钠肽（BNP）水平，以及出院医嘱用药情况。出院后通过电话或门诊随访3年，观察终点为心脑血管源再住院或死亡。结果　两组高血压、慢性阻塞性肺疾病（COPD）、ACS、CHF、左心室扩大检出率，以及BNP≥220 ng/L、出院医嘱口服β-受体阻滞剂（β-RB）比例比较，差异均有统计学意义（P<0.05）。两组因ACS、脑卒中及恶性心律失常引起的再住院率比较，差异均无统计学意义（P>0.05）。AHFrEF组因心力衰竭引起的再住院率高于AHFpEF组，且总再住院率高于AHFpEF组（P<0.05）。多因素Cox比例风险回归模型分析显示，高血压〔HR=1.450,95%CI（1.036,2.030）〕和BNP≥220 ng/L〔HR=1.894,95%CI（1.327,2.702）〕是AHF患者再住院的独立危险因素（P<0.05）。AHFrEF组1、2、3年生存率分别为98%、95%、85%，AHFpEF组1、2、3年生存率分别为98%、94%、86%。两组生存曲线比较，差异有统计学意义（χ2=6.656，P=0.010）。结论　AHFrEF患者3年内因心力衰竭引起的再住院率高于AHFpEF患者，3年生存率低于AHFpEF患者；高血压和高水平BNP是AHF患者再住院的独立危险因素。临床应加强对AHFrEF患者的随访，改善合并高血压患者的血压控制水平。

关键词: 心力衰竭, 每搏输出量, 住院, 预后, 高血压, 利钠肽, 脑