Abstract: Background　In China，with the intensification of population aging，the incidence of heart failure（HF） is on the rise year by year，with a 5-year mortality rate of over 50%.HF has become a “fortress” in the field of cardiovascular medicine that needs to be conquered.The prevention and treatment of HF are an important health task in our country，so understanding the clinical manifestations of HF is of great significance.Objective　To explore the clinical characteristics of HF patients in southwest China，offering a scientific basis for the prevention and treatment of HF in this region.Methods　This study was conducted following a retrospective design.Participants were 3 674 HF inpatients selected from 12 hospitals（the First Affiliated Hospital of Dali University，Baoshan People's Hospital，the First People's Hospital of Zhaotong，Dehong People's Hospital，Qujing First People's Hospital，Guizhou Provincial People's Hospital，Qiannan People's Hospital，Xingyi People's Hospital，Qiandongnan People's Hospital，Qianxinan People's Hospital，the People's Hospital of Guang'an City，the First Affiliated Hospital of Chongqing Medical University） in Southwest China from January 2009 to October 2016.After excluding those with incomplete，missing or wrong data，3 516 cases were finally included.Sex，age，NYHA class，etiology，levels of left ventricular ejection fraction （LVEF），left ventricular end-diastolic diameter （LVEDD），brain natriuretic peptide （BNP），electrolytes，thyroxine，anemia，total bilirubin，uric acid and other clinical characteristics were compared between them.Results　Among the participants，the percentages of NYHA class Ⅱ，Ⅲ，and Ⅳ HF were 25.40%（893/3 516），41.67%（1 465/3 516） and 32.93%（1 158/3 516），respectively.The percentages of HF caused by coronary heart disease，hypertension and cardiomyopathy were 32.45%（1 142/3 516），19.45%（684/3 516） and 13.00%（457/3 516），respectively.Except for 777 cases，2 739 had echocardiography results.The percentages of reduced ejection fraction（HFrEF），mid-range ejection fraction（HFmrEF） and preserved ejection fraction（HFpEF） were 26.76%（733/2 739），12.23%（335/2 739） and 61.01%（1 671/2 739），respectively.Worse cardiac function was associated with higher prevalence of HFrEF and HFmrEF，lower prevalence of HFpEF and LVEF，higher LVEDD and higher BNP（P<0.05）．The prevalence of hypokalemia and hyperkalemia was 16.21%（481/2 967），and 1.38%（41/2 967），respectively.Worse cardiac function was associated with higher prevalence of hypokalemia（P<0.05）．Serum sodium level varied significantly by NYHA class（P<0.05）．NYHA class Ⅳ HF patients had lower average serum sodium level than NYHA class Ⅱ and Ⅲ HF patients（P<0.05）．Except for 677 cases，all the cases （n=2 839） had serum calcium data.The prevalence of hypocalcemia and hypercalcemia was 66.43%（1 886/2 839），and 2.40%（68/2 839），respectively.Cardiac function showed a negative association with serum calcium level （P<0.05）．NYHA class was positively associated with the prevalence of ESS，but negatively associated with serum FT3 and TT3 levels（P<0.05）．The prevalence of anemia changed according to NYHA class（P<0.05）．NYHA class Ⅲ and Ⅳ HF patients had higher prevalence of anemia than NYHA class Ⅱ HF patients（P<0.01）．The worse the cardiac function was，the higher the prevalence of hyperbilirubinemia and hyperuricemia，and serum total bilirubin and uric acid became （P<0.05）．Conclusion　Most of the HF patients in Southwest China are the young old.HF is mainly caused by coronary heart disease，with HFpEF as a major manifestation.Serum potassium，sodium and calcium levels are all associated with NYHA class.Moreover，the prevalence of ESS，anemia，hyperbilirubinemia and hyperuricemia is also associated with NYHA class.

Key words: Heart failure, Clinical features, Etiology, Cardiac function grading

摘要： 背景　随着我国人口老龄化程度加深，心力衰竭发病率逐年上升，5年病死率达半数以上，是心血管领域尚未攻克的“堡垒”，防治心力衰竭已成为我国卫生事业重要组成部分。了解心力衰竭临床特征对其防治有深远意义。目的　了解中国西南地区心力衰竭患者临床特征，为本地区心力衰竭的防治提供科学依据。方法　采用回顾性分析方法，选取2009年1月—2016年10月大理大学第一附属医院、云南省保山市人民医院、云南省昭通市第一人民医院、云南省德宏州人民医院、云南省曲靖市第一人民医院、贵州省人民医院、贵州省黔南州人民医院、贵州省兴义市人民医院、贵州省黔东南州人民医院、贵州省黔西南州人民医院、四川省广安市人民医院、重庆医科大学附属第一医院因心力衰竭入院的3 674例患者，剔除资料不全、缺失或错误的病例，共3 516例。分析患者性别、年龄、心功能分级、病因分布、左心室射血分数、左心室舒张末期内径、脑钠肽（BNP）、电解质、甲状腺素水平、贫血、总胆红素、尿酸水平等临床特征。结果　3 516例患者中心功能Ⅱ级893例（25.40%），Ⅲ级1 465例（41.67%），Ⅳ级1 158例（32.93%）；病因中以冠心病1 142例（32.45%），高血压684例（19.45%），心肌病457例（13.00%）为主；3 516例患者中777例无心脏彩超结果，2 739例患者中射血分数降低的心力衰竭（HFrEF）733例（26.76%），射血分数中间值的心力衰竭（HFmrEF）335例（12.23%），射血分数保留的心力衰竭（HFpEF）1 671例（61.01%）。心功能越差，HFrEF、HFmrEF发病率越高，HFpEF发病率、左心室射血分数越低，左心室舒张末期内径越大，BNP水平越高（P<0.05）。患者低钾血症发生率为16.21%（481/2 967），高钾血症发生率为1.38%（41/2 967）。心功能越差，低钾血症发病率越高（P<0.05）。不同心功能分级患者血钠水平比较，差异有统计学意义（P<0.05）；其中心功能Ⅳ级患者血钠水平低于心功能Ⅱ级、Ⅲ级患者（P<0.05）。3 516例患者中677例患者无血钙数据，2 839例患者中低钙血症发病率为66.43%（1 886/2 839），高钙血症发病率为2.40%（68/2 839）。心功能越差，血钙水平越低（P<0.05）。随着心功能分级增加，正常甲状腺功能病态综合征（ESS）发病率升高，游离三碘甲状腺原氨酸（FT3）、总三碘甲状腺原氨酸（TT3）水平下降（P<0.05）。不同心功能分级患者贫血发病率比较，差异有统计学意义（P<0.05）；其中心功能Ⅲ级、Ⅳ级患者贫血发病率高于心功能Ⅱ级患者（P<0.01）。心功能越差，高胆红素血症发病率越高，总胆红素水平越高（P<0.05）。心功能越差，高尿酸血症发病率越高，尿酸水平越高（P<0.05）。结论　西南地区心力衰竭患者以年轻老年人为主，冠心病为主要病因，以HFpEF为主。血钾、钠、钙水平与心功能分级有关，ESS、贫血、高胆红素血症、高尿酸血症发病率与心功能分级有关。

关键词: 心力衰竭, 临床特点, 病因, 心功能分级