规范药物治疗的射血分数重度减低的扩张型心肌病患者长期预后的影响因素分析  

Analysis of influential factors on long-term prognosis in patients with dilated cardiomyopathy complicated with severely reduced ejection fraction with optimal medication treatment

作　　者：林雪[1] 戴晓艳[2] 陈未[1] 郭潇潇[1] 徐瑞燚[1] 朱燕林[1] 严晓伟[1] 朱文玲[1] 方理刚[1] Lin Xue;Dai Xiaoyan;Chen Wei;Guo Xiaoxiao;Xu Ruiyi;Zhu Yanlin;Yan Xiaowei;Zhu Wenling;Fang Ligang(Department of Cardiology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Science,Beijing 100730,China;International Medical Services Department,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Science,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院,北京协和医院心内科,100730 [2]中国医学科学院北京协和医学院,北京协和医院国际医疗部,100730

出　　处：《中国心血管杂志》2020年第2期111-115,共5页Chinese Journal of Cardiovascular Medicine

基　　金：国家自然科学基金项目(81670349);北京市自然科学基金项目(7172166);中国医学科学院医学与健康科技创新工程(2019-I2M-2-2003)。

摘　　要：目的探讨左室射血分数(LVEF)重度减低的扩张型心肌病患者在规范药物治疗的情况下长期生存的相关因素。方法入选北京协和医院超声数据库中1992—2011年经过规范治疗的59例LVEF低于35%的扩张型心肌病患者,收集患者的临床数据、就诊信息及预后情况进行分析,2014年6月进行中期随访,2018年6月进行最终生存随访。结果在本组患者中,纽约心脏病协会(NYHA)心功能分级Ⅲ~Ⅳ级的患者35例(59.3%),平均左室舒张末内径为(72±10)mm,双平面LVEF为25%±9%,血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)入组时使用率为86.4%,随访过程中剂量达标率为30.6%(15例/49例);β受体阻滞剂入组时使用率为88.1%,随访过程中剂量达标率为25.0%(13例/52例);螺内酯使用率为67.8%;植入辅助器械(心脏再同步治疗、植入型心律转复除颤器和心脏再同步治疗除颤器)的使用率为27.1%。中位存活时间83(40,138)个月,最短生存时间为9个月,最长为296个月(约25年),46.3%(19例/41例)的患者死于心原性休克,19.5%(8例/41例)的患者猝死。生存分析结果提示,β受体阻滞剂剂量达标(HR:0.128,95%CI:0.037~0.447,P=0.001)和规律随诊(HR:0.222,95%CI:0.071~0.691,P=0.009)与长期生存相关。结论LVEF低于35%的扩张型心肌病患者经过规范治疗,可以达到长期生存,其中规律随诊与长期生存有关。Objective To explore the influential factors of long-term prognosis in patients with dilated cardiomyopathy(DCM)complicated with severely reduced left ventricular ejection fraction(LVEF)with optimal medication treatment(OMT).Methods The 59 DCM patients with an LVEF below 35%who received OMT in Peking Union Medical College Hospital from 1992 to 2011 were enrolled.The clinical data,visit information,and prognostic data were collected and analyzed.Mid-term follow-up was performed in June of 2014 and the final survival follow-up was performed in June of 2018.Results Patients with cardiac function gradeⅢtoⅣof the New York Heart Association(NYHA)were 35(59.3%)cases.The average left ventricular end-diastolic diameter(LVEDD)was 72±10 mm,and biplanar LVEF was 25%±9%.Usage ratio of angiotensin-converting enzyme inhibitor/angiotensinⅡreceptor antagonist(ACEI/ARB)was 86.4%on enrollment,and the ratio of target dosage during follow-up was 30.6%(15/49);beta-blockers were used at a rate of 88.1%on enrollment,and the ratio of target dosage during follow-up was 25.0%(13/52);ratio of spironolactone was 67.8%;ratio of implanted devices(heart resynchronization treatment,implantable cardioverter defibrillator and cardiac resynchronization therapy defibrillator)was 27.1%.The median survival time was 83(40,138)months.The shortest survival time was 9 months,while the longest time was 296 months(about 25 years).46.3%(19/41)of patients died of cardiogenic shock.Sudden death occurred in 19.5%(8/41)of patients.Survival analysis showed that the target dosage ofβ-blockers(HR:0.128,95%CI:0.037-0.447,P=0.001)and regular follow-up(HR:0.222,95%CI:0.071-0.691,P=0.009)were related to the long-term survival.Conclusions DCM patients with LVEF below 35%can achieve long-term survival after OMT,and the regular follow-up is associated with long-term survival.

关 键 词：射血分数减低的心力衰竭 心肌病 扩张型 随诊 长期生存 

分 类 号：R54[医药卫生—心血管疾病]