口服袢利尿剂剂量与慢性心力衰竭全因死亡率的关系  

The relationship between oral doses of loop diuretic and all-cause mortality in patients with chronic heart failure

作　　者：郝素芳[1] 侯翠红[1] 裴娟慧[1] 冉玉琴[1] 张澍[1] 浦介麟[1] 

机构地区：[1]北京协和医学院 中国医学科学院国家心血管病中心阜外医院

出　　处：《中国分子心脏病学杂志》2012年第6期333-336,共4页Molecular Cardiology of China

摘　　要：目的研究口服袢利尿剂剂量与慢性心力衰竭(心衰)患者全因死亡率的关系。方法入选并随访1197例(1120例获得用药资料)慢性心衰患者.男性占81.7%,平均年龄56.5±13.6岁,平均左室射血分数(LVEF)35.6±8.9%;全因死亡为随访终点。先比较不同口服袢利尿剂剂量(0、≤20、20～40、>40mg/日呋塞米当量)人群其他预后相关因素分布的差异,再应用Kaplan-Meier曲线及Log-rank检验对不同剂量人群的生存率进行描述及比较,多元Cox回归用于分析口服袢利尿剂剂量是否为心衰死亡的独立预测因子。结果完成随访1025例(失访率14.4%),死亡360例(35.1%);随访中位数44个月。平均袢利尿剂剂量34.26±2.67mg/日呋塞米当量。应用不同袢利尿剂剂量的心衰患者在合并症、血压、LVEF、多种检验项目及用药方面存在显著差异。不同剂量心衰人群的死亡率分别为19.2%、29.6%、39.8%及55.4%,随着袢利尿剂应用剂量增加而增高(P<0.001);校正其他影响因素后,口服袢利尿剂剂量与心衰患者不良预后独立相关。剂量每增加10mg/日呋塞米当量,心衰死亡风险增加1.072倍(P<0.001)。服用≤20mg/日、20-40mg/日及>40mg/日呋塞米当量心衰人群的死亡风险分别是未服用者的1.575倍(P=0.023)、1.958倍(P=0.001)及2.543倍(P<0.001)。结论虽然年龄、体重指数、LVEF、合并室速、是否应用血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂、应用袢利尿剂剂量、血红蛋白、总胆红素、尿酸均与心衰预后相关。应用袢利尿剂且随着剂量增加,心衰的死亡风险增高。Objective To investigate the dose-dependent relationship between oral loop diuretic and all-cause mortality in patients with chronic heart failure（CHF）.Methods A cohort of 1,197 consecutive patients （medication data available in 1120 cases） with CHF were recruited and followed up. The cohort was 81.7% of male, with a mean age of 56.5 ± 13.6 years and a mean left ventricular ejection fraction（LVEF） of 35.6±8.9%. The end point was all-cause death. The relationship between different dosages of oral equivalent loop diuretics（OLD） furosemide （0, 0 to20, 20 to 40 and〉40mg daily） and other clinical features was analyzed. Kaplan-Meier curves and Log-rank test were used independently to describe sur- vival rate in different dose groups. The multivariate Cox regression model was performed to reveal the predictive values of OLD dose for all cause mortality. Results During a median follow-up period of 44 months, 1025 cases were successfully followed up（14.4% lost）, of them 360 individu- als died. The mean furosemide dose equivalence was 34.26±2.67mg. There were significant differences in blood pressure, LVEF, laboratory results, complications and medication between patients with different doses of OLD. The mortality rates were well correlated with increasing in doses of OLD（19.2%,29.6%,39.8% and 55.4% respectively, P〈0.001）. After adjustment for other risk factors, OLD dose remained an independent predictor of mortality in patients with CHF. The increasing daily dose by 10 mg furosemide equivalent was associated with 1.072 -fold higher risk of mortal- ity （P〈0.001）. Compared with those who did not take OLD, the hazard ratios for patients taking 〈20 mg, 20 to 40 mg and 〉 40 mg daily furosemide equivalent were 1.575 （P=0.023）, 1.958（P=0.001） and2.543（P〈0.001）respectivelyo Conclusions. Although age , body mass index, LVEF, history of ventricular tachycardia, angiotensin converting enzyme inhibitor / angiotensin receptor blocker and OLD dose, hemoglobin, total bilirubin,

关 键 词：慢性心力衰竭 死亡率 袢利尿剂 

分 类 号：R541.6[医药卫生—心血管疾病]