中国老年瓣膜性心脏病不同性别住院患者的流行病学特点:一项全国性多中心横断面研究  

Sex-specific epidemiological characteristics of chinese elderly patinets with valvular heart disease: A national multicenter cross-sectional study

作　　者：张斌[1] 许海燕[1] 高润霖[1] 吴永健[1] China DVD研究组 ZHANG Bin;XU Hai-yan;GAO Run-lin;WU Yong-jian;China-DVD Investigators(Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,中国医学科学院阜外医院,北京100037

出　　处：《中国医刊》2020年第1期26-30,共5页Chinese Journal of Medicine

基　　金：国家科技支撑计划项目(2015BAI12B02)

摘　　要：目的探究中国老年瓣膜性心脏病(valvular heart disease,VHD)不同性别住院患者在疾病类型、病因分布及手术干预方面的差异。方法基于China DVD(China elDerly Valvular Disease;NCT02865798)全国多中心前瞻性队列,纳入年龄≥60岁的8638例住院期间超声心动图发现中度及以上瓣膜病变的患者(排除了原队列中仅因既往瓣膜手术入院的患者),按照性别分层进行横断面描述。结果在8638例VHD患者中,男性占52.5%。在疾病类型上,男性主动脉瓣反流(aortic regurgitation,AR)和主动脉瓣狭窄(aortic stenosis,AS)的比例(分别为13.6%、6.0%)明显高于女性(分别为6.8%、3.9%),而二尖瓣狭窄(mitral stenosis,MS)的比例(1.8%)明显低于女性(5.0%),差异均有显著性(P<0.001)。无论男女,退行性变已逐渐成为AS、AR的首要病因,而MS则仍以风湿为主。但值得注意的是,二尖瓣反流患者中,男性缺血性病因占比仍略高于退行性变;而女性则以退行性变最常见。在1082例接受瓣膜手术的单纯左心VHD患者中,男性和女性的术后院内死亡率均低于5%。女性AS患者接受瓣膜手术的比例显著高于男性(分别为67.9%、55.4%,P=0.010),且术后院内死亡率有低于男性的趋势(分别为0.97%、4.73%,P=0.146);反之,在AR患者中,男性接受瓣膜手术的比例高于女性(分别为33.2%、24.2%,P=0.007),且术后院内死亡率有低于女性的趋势(分别为0.98%、4.34%,P=0.104)。在二尖瓣疾病中,男性和女性患者接受瓣膜手术的比例及术后院内死亡率均无明显差异。结论在中国老年VHD住院患者中,男性和女性患者的疾病类型、手术率存在明显差异,术后死亡率也有存在差异的趋势。Objective This study aimed to investigate the potential sex-specific differences concerning distribution patterns, etiology, and valvular surgery of noteworthy valvular heart disease(VHD) in the elderly Chinese population. Method Based on the China elDerly Valvular Disease(China DVD;NCT02865798), a national multicenter prospective cohort, 8638 patients aged ≥60 years with at least moderate VHD by echocardiography were included. Cross-sectional descriptions were performed by gender stratification. Result Among 8638 patients with VHD, males accounted for 52.5%, with aortic regurgitation(AR, 13.6 vs. 6.8%, P<0.001) and aortic stenosis(AS;6.0% vs. 3.9%, P<0.001) contributing more of the VHD diagnosis than women. By contrast, the proportion of women with mitral stenosis(MS;5.0% vs. 1.8%, P<0.001) was much higher than men. While the rheumatic causes stayed significant in MS, a growing predominance of degenerative causes was detected regardless of gender in patients with aortic VHD. Notably, the proportion of ischemic causes in men with mitral regurgitation was slightly higher than degenerative causes,while in women, the degenerative causes were the primary etiology. In the 1082 patients with single left heart VHD who underwent valvular surgery, the postoperative mortality was less than 5% both in men and women. In patients with AS, the proportion of women undergoing valve surgery was significantly higher than that of men(67.9% vs. 55.4%, P=0.010), and postoperative mortality tended to be lower than men(0.97% vs. 4.73%, P=0.146). In AR patients, men were more likely to undergo valve surgery(33.2% vs. 24.2%, P=0.007) and tended to have lower postoperative mortality(0.98% vs. 4.34%, P=0.104). In mitral valve disease, the proportion of patients undergoing valvular surgery for different sexes is essentially the same. No significant sex-related differences were found in postoperative mortality. Conclusion Among the elderly patients with VHD in China, significant sexrelated differences are noted concerning the distribution

关 键 词：瓣膜性心脏病 流行病学 病因学 性别分布 

分 类 号：R542.5[医药卫生—心血管疾病]