女性心力衰竭患者的临床特点及预后  

Clinical characteristics and prognosis of female patients with heart failure

作　　者：季旻晔[1] 杨洁[2] 李慧[3] 张凤如[2] 

机构地区：[1]上海交通大学医学院附属瑞金医院嘉定北院心血管内科,上海201801 [2]上海交通大学医学院附属瑞金医院老年病科,上海200025 [3]上海交通大学医学院附属瑞金医院卢湾分院心血管内科,上海200020

出　　处：《内科理论与实践》2015年第3期181-184,共4页Journal of Internal Medicine Concepts & Practice

摘　　要：目的:研究女性心力衰竭(心衰)患者在年龄、合并疾病、心功能水平、用药等方面与男性患者的差异及对预后的影响。方法:收集2008年8月到2014年7月3所医院门诊及住院心衰患者1 444例,按性别分组,比较2组患者的基本临床资料、病因、心脏超声(心超)情况、用药及预后。结果:平均随访(18.02±17.85)个月。女性患者的平均年龄高于男性患者(P<0.05),且>75岁患者比例明显高于男性患者(P=0.000),合并有冠心病的比例小于男性患者(P<0.05)。女性患者的缺血性心肌病比例低于男性患者,而扩张型心肌病、高血压性心脏病患者比例高于男性患者。女性患者的心超各项指标(左心房、左心室大小,室间隔、左心室后壁厚度,左心室射血分数等)均好于男性(均P<0.05),但氨基末端脑钠肽前体(NT-pro BNP)水平高于男性(P<0.05)。整体用药上女性患者与男性患者无差异(P>0.05),但以血管紧张素Ⅱ受体拮抗剂(ARB)类药物替代血管紧张素转化酶抑制剂(ACEI)类药物的患者比例高于男性(P<0.05),而肾上腺素β受体阻滞剂能达到最大治疗剂量的比例低于男性(P<0.05)。2组患者的预后(心衰再住院率及死亡率)未见明显差异(P>0.05)。结论:女性患者在心衰病因、心超指标、用药等方面与男性患者存在差异,但整体预后无明显不同。Objective To study the differences between female and male heart failure patients in age, complications,echocardiography（UCG）, medication and its influence on prognosis. Methods An analysis was performed on 1 444 cases of patients diagnosed with chronic heart failure（CHF） from August, 2008 to July, 2014. Patients were grouped by sex to compare the clinical characteristics including age, complications, cause of CHF, UCG, medication and prognosis between female and male patients. Results The patients were followed for（18.02±17.85） months. The age and ratio of patients over75 years of age was higher in female patients than that in male patients, while the diagnosis with coronary disease was lower in female patients（P〈0.05）. As for the cause of CHF, female patients were more likely to have non-ischemic disease（P〈0.05）. The UCG parameters of female patients were better than that of male patients（P〈0.05）. Female patients had higher level of N-terminal pro-brain natriuretic peptide（NT-pro BNP）（P〈0.05）. Generally, there was no difference in medication between female and male groups（P〉0.05）, however, angiotensin Ⅱ receptor blocker（ARB） as an alternative of angiotensin converting enzyme inhibitor（ACEI） was more widely used in female patients（P〈0.05）. No significant difference in prognosis was found between the two groups（P〉0.05）. Conclusions Despite the differences of cause of CHF, UCG parameters and medication between male and female patients, the prognosis of the two groups was similar.

关 键 词：心力衰竭 女性 临床特点 

分 类 号：R541.6[医药卫生—心血管疾病]