植入型心律转复除颤器一级预防恰当治疗的多因素回归分析  

Multivariate logistic regression analysis of appropriate therapy of implantable cardioverter defibrillator for primary prevention

作　　者：梁淑敏 谢双伦[1] 陈煜阳 苏子焯[1] 袁沃亮[1] 陈样新[1] 周淑娴[1] 王景峰[1] Liang Shumin;Xie Shuanglun;Chen Yuyang;Su Zizhuo;Yuan Woliang;Chen Yangxin;Zhou Shuxian;Wang Jingfeng(Department of Cardiology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院心内科,广州510120

出　　处：《中华心律失常学杂志》2019年第1期28-32,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金(81670364);广东省科技发展专项资金(2016A030313356).

摘　　要：目的目前临床指南均采纳左心室射血分数(LVEF)≤35%作为植入心律转复除颤器(ICD)为心脏性猝死一级预防。然而基于此标准植入ICD的患者,获得恰当治疗率极低,本研究旨在通过对植入ICD作为一级预防患者进行分析,寻找其他临床相关指标,筛选出ICD一级预防恰当治疗的更高危患者。方法本研究为单中心回顾性研究,连续收集2000年7月至2015年12月在中山大学孙逸仙纪念医院心血管内科植入ICD/心脏再同步治疗除颤器(CRT-D)的358例患者的资料。纳入2008年美国心脏病学会/美国心脏协会/美国心律学会(ACC/AHA/HRS)器械植入治疗心律失常的指南中植入ICD一级预防的Ⅰ类推荐、CRT-D的Ⅰ类和Ⅱa类推荐的患者。根据随访期间ICD/CRT-D是否有恰当治疗分成两组:无恰当治疗组99例,有恰当治疗组24例;对患者年龄、性别等基线资料,血生化、超声心动图、24h动态心电图等指标进行分析,并寻找ICD/CRT-D一级预防恰当治疗的独立危险因子。结果本研究共入选123例患者,其中男性占78%,年龄(61±12)岁。随访(37±34)个月,ICD/CRT-D恰当治疗率为19.51%。通过多自变量Logistic回归分析发现,估算的肾小球滤过率(eGFR)<45ml·min^-1·(1.73m^2)^-1(OR=2.749,95%CI1.008~7.496,P=0.048)、心房颤动(房颤)(OR=3.141,95%CI1.095~9.013,P=0.033)是ICD/CRT-D一级预防恰当治疗的独立危险因子。结论房颤、eGFR<45ml·min^-1·(1.73m^2)^-1可能是ICD/CRT-D一级预防患者获得恰当治疗的独立危险因子。Objective According to current guidelines,most patients with left ventricular ejection fraction(LVEF)≤35%could benefit from prophylactic implantable cardioverter-defibrillator(ICD)implantation,particularly in the setting of symptomatic heart failure.Current risk stratification strategies fail to identify patients at risk of sudden cardiac death(SCD)in larger population groups encompassing a greater number of potential SCD victims.The goal of this study was to find out new risk stratification markers in combination with LVEF≤35%for ICD primary prevention.Methods Consecutive 358 patients implanted ICD/cardiac resynchronization therapy defibrillator(CRT-D)in Department of Cardiovascular Medicine,Sun Yat-sen Memorial Hospital from July 2000 to December 2015 were retrospectively analyzed.The patients with LVEF≤35%implanted ICD/CRT-D as primary prevention were included in this study.The end point was the first appropriate ICD therapy.Independent risk factors of the appropriate ICD therapy as primary prevention was analyzed with multivariate logistic regression analysis.Base on the program control records,the patients were divided into negative group and positive group.The baseline characteristics,blood biochemical indices,ultrasonic cardiogram parameters,holter indices were analyzed.Results In total,123 patients[age(61±12)years,78%male]were included in this study.During the follow-up of(37±34)months,the rate of appropriate therapy from ICD/CRT-D was 19.51%.Using multivariate logistic regression analysis,it was found that eGFR<45 ml·min^-1·(1.73 m^2)^-1(OR=2.749;95%CI 1.008-7.496,P=0.048)and atrial fibrillation(OR=3.141;95%CI 1.095-9.013,P=0.033)were identified as the independent risk factors of appropriate therapy of ICD as primary prevention.Conclusion Atrial fibrillation and eGFR<45 ml·min^-1·(1.73 m^2)^-1 may be the rish factors of ICD appropriate therapy for primary prevention.

关 键 词：猝死 心脏 一级预防 植入型心律转复除颤器 

分 类 号：R541.7[医药卫生—心血管疾病]