慢性心力衰竭患者性别差异对预后的影响因素研究  

Clinical study of different risk factors on prognosis among chronic heart failure patients of different genders

作　　者：褚松筠[1] 彭芬[1] 赵静[1] 李葚煦[1] 崔晓静[1] 刘琳[1] 丁文惠[1] 

机构地区：[1]北京大学第一医院心内科,100034

出　　处：《中华老年心脑血管病杂志》2014年第10期1028-1031,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：首都医学发展科研基金(2009-3026)

摘　　要：目的：对慢性心力衰竭（心衰）患者进行随访，评估其病因、合并疾病、临床特征与心衰预后指标的相关性，分析性别差异对患者预后影响的相关危险因素。方法连续纳入慢性心衰患者228例，每3个月门诊随访，收集临床资料、心脏超声参数等。记录患者心衰再入院、心源性死亡以及全因死亡终点发生情况。分析在不同性别中不良预后的相关危险因素。结果与男性比较，女性年龄偏大，合并高血压、心房颤动、慢性肾脏病和舒张功能不全明显升高（P＜0．01）。对影响预后因素分析显示，女性心房颤动是心衰复发的独立危险因素（OR＝6．874，95％ CI：1．932～24．459，P＝0．003），急性期 LVEF降低和肺动脉压力升高是心源性死亡的独立危险因素（OR＝0．917，95％ CI：0.851～0．989，P＝0．024；OR＝1．107，95％ CI：1．021～1．200，P＝0．013），稳定期心功能分级是全因死亡的独立危险因素（OR＝12．484，95％ C I：1．117～139．495，P＝0．040）。结论慢性心衰预后的危险因素存在性别差异。对女性患者控制心房颤动、优化舒张性心衰治疗对减少心衰复发，降低心源性死亡可能较男性更有意义。Objective Serial follow-up study was conducted in chronic heart failure cohort of our center .Etiology ,comorbidity ,clinical characteristics of these patients and the incidence of adverse events were analyzed ,focusing on the influence of gender difference of risk factors .Methods Consecutive 228 patients diagnosed as chronic heart failure were enrolled .History ,physical exam-ination findings ,lab and ultrasonographicdata were collected .Average follow-up were 23 .6 ± 6.5 months .End points were defined as re-admission of heart failure ,death of cardiac origin ,and all-cause death .The risk factors of female and male patients were analyzed and compared .Results No significant difference of these prognostic events was detected between genders .However ,fe-male patients were older than males ,complicated with more hypertension ,atrial fibrillation ,chron-ic kidney disease ,and diastolic dysfunction （P〈0 .01） .In females ,atrial fibrillation was an inde-pendent risk factor of recurrence of decompensated heart failure （OR=6 .874 ,95% CI：1 .932 -24.459 ,P=0 .003）;low LVEF and high pulmonary artery pressure in acute phase independently predicted deaths of cardiac origin （OR=0 .917 ,95% CI：0 .851 -0 .989 ,P=0 .024 ;OR= 1 .107 , 95% CI：1 .021-1 .200 ,P=0 .013）;NYHA functional class in chronic phase independently predic-ted all-cause deaths （OR=12 .484 ,95% CI：1 .117 -139 .495 ,P= 0 .040） .Conclusion Different risk factors of adverse prognosis were found between genders .Optimization of management on at-rial fibrillation and diastolic heart failure are more meaningful among females .

关 键 词：心力衰竭 高血压 心房颤动 预后 性别因素 

分 类 号：R541.6[医药卫生—心血管疾病]