扩张型心肌病心力衰竭患者临床特点及预后分析  

The clinical features and prognosis of dilated cardiomyopathy patients with heart failure

作　　者：张新雨[1] 徐予[1] 石亚楠[1] 夏长伟 

机构地区：[1]郑州大学人民医院(河南省人民医院)心内科,河南450003

出　　处：《社区医学杂志》2017年第7期17-21,共5页Journal Of Community Medicine

摘　　要：目的探讨扩张型心肌病(dilated cardiomyopathy,DCM)心力衰竭患者的临床特点及影响其预后的因素。方法 398例DCM均经过超声心动图证实左室射血分数(left ventricular ejection fraction,LVEF)≤45%,将患者分为LVEF≤35%(A组,n=242)和LVEF36%~45%(B组,n=156)两组,本研究的研究终点为全因死亡。计量资料比较用独立样本t检验,计数资料比较采用χ~2检验,应用多因素Cox回归模型分析全因死亡率的影响因素,生存分析采用Kaplan-Meier生存曲线来描述累计生存率,P<0.05为差异有统计学意义。结果共有90例患者死亡,两组患者的1年生存率分别为91.5%、95.1%,2年生存率分别为76.8%和91.2%,3年生存率分别为64.8%和89.6%,4年生存率分别为49.5%和68.9%(χ~2=14.22,P<0.05)。多因素Cox回归分析显示,NYHAⅣ级、使用β受体阻滞剂、年龄、BMI 4个因素对DCM心力衰竭患者的全因死亡率有影响(RR=1.024,95%CI为1.009~1.040;RR=0.525,95%CI为0.396~0.697;RR=2.261,95%CI为1.484~3.445;RR=0.577,95%CI为0.353~1.941,均P<0.05)。结论 DCM心力衰竭患者的预后较差,特别是LVEF≤35%的患者,需要临床医生重视并积极治疗。NYHAⅣ级、使用β受体阻滞剂、年龄、BMI 4个因素对DCM心力衰竭患者的全因死亡率有影响。Objective To explore the clinical features and prognostic factors of dilated cardiomyopathy（DCM） patients with heart failure. Methods 398 cases were confirmed by echocardiography left ventricular ejection fraction（LVEF） ≤ 45% of DCM were divided into two groups： LVEF ≤ 35%（group A, n=242） and LVEF36%-45%（group B, n=156）, the study endpoint was all-cause death. Comparison of the measurement data with independent samples t test, count data comparison using chi square test, the use of multi-factor Cox regression model to analyze the factors of all-cause mortality, survival analysis using Kaplan-Meier survival curve to describe the cumulative survival rate. P〈0.05 was considered statistically significant. Results The 1-year survival rates of two groups were 91.5% and 95.1%, respectively. The 2-year survival rates of two groups were 76.8% and 91.2%, respectively. The 3-year survival rates of two groups were 64.8% and 89.6%, respectively. The 4-year survival rates of two groups were 49.5% and 68.9%（χ^2=14.22, P〈0.05）. Cox regression analysis showed that the predictors of all-cause mortality were NHYA Ⅳ level, use of β receptor antagonist, age, BMI in DCM patients with heart failure（RR=1.024, 95%CI 1.009-1.040; RR=0.525, 95%CI0.396-0.697; RR=2.261, 95%CI 1.484-3.445; RR=0.577, 95%CI 0.353-1.941, all P〈0.05）. Conclusion DCM patients with heart failure have a poor prognosis, especially for patients with LVEF ≤ 35% and this need our clinicians pay attention and active treatment. The factors of NHYA Ⅳ level, use of β receptor antagonist, age, BMI affect the survival of DCM patients with heart failure.

关 键 词：扩张型心肌病 心力衰竭 临床特点 预后 

分 类 号：R541[医药卫生—心血管疾病]