慢型克山病患者左室射血分数恢复正常的预测因素研究  

Predictors of recovery of normal left ventricular ejection fraction in patients with chronic Keshan disease

作　　者：种冠峰[1] 李伟国 王秀红[1] 李丹丹[3] 王园园[1] 张文明[1] 王明亮[1] 李为波 王静[4] 屈福荣[1] Chong Guanfeng;Li Weiguo;Wang Xiuhong;Li Dandan;Wang Yuanyuan;Zhang Wenming;Wang Mingliang;Li Weibo;Wang Jing;Qu Furong(Department of Keshan Disease and Arsenism,Shandong Institute for Endemic Diseases Control and Treatment,Jinan 250014,China;Department of Keshan Disease and Arsenism,Qingzhou Institute for Endemic Disease Prevention and Control,Qingzhou 262500,China;Institute of Keshan Disease,Center for Endemic Disease Control,Chinese Center for Disease Control and Prevention,Harbin Medical University,Harbin 150081,China;Department of Cardiovascular Medicine,Jinan Central Hospital,Jinan 250012,China)

机构地区：[1]山东省地方病防治研究所克山病与砷中毒科,济南250014 [2]山东省青州市地方病防治研究所克山病与砷中毒科,262500 [3]哈尔滨医科大学中国疾病预防控制中心地方病控制中心克山病防治研究所,150081 [4]济南市中心医院心血管内科,250012

出　　处：《中华地方病学杂志》2021年第4期273-278,共6页Chinese Journal of Endemiology

基　　金：山东省医药卫生科技发展计划项目(2016WS0373、2013WS0178)。

摘　　要：目的:探讨慢型克山病(CKD)患者在标准抗心力衰竭治疗后左室射血分数(LVEF)恢复正常的预测因素。方法:2013年6月至2017年10月,在山东省8个克山病病区县(市)选择CKD患者作为研究对象。收集患者初诊时人口统计学资料及可能与LVEF恢复正常相关的临床指标,并对患者进行标准抗心力衰竭治疗。随访至2019年10月或至全因死亡,采用成组设计,根据LVEF是否恢复正常(LVEF≥50%为恢复正常)将患者分为恢复组和未恢复组,采用多因素logistic回归分析LVEF恢复正常的预测因素。结果:共有98例CKD患者纳入本研究,年龄为(47.51±12.84)岁;体质指数(BMI)为(23.18±4.92)kg/m 2;LVEF为(39.54±8.26)%;男性占65.31%(64/98);美国纽约心脏病协会(NYHA)心功能Ⅱ级和Ⅲ级分别占46.94%(46/98)、53.06%(52/98)。随访时间中位数为26个月,28例(28.57%)患者LVEF恢复正常,LVEF由基线的(43.27±7.85)%增加至(58.74±6.07)%,二者比较差异有统计学意义(t=8.25,P<0.01);70例(71.43%)患者LVEF未恢复正常,LVEF由基线的(37.84±6.93)%增加至(42.94±7.31)%,二者比较差异有统计学意义(t=4.24,P<0.01)。28例LVEF恢复正常患者的恢复时间中位数为14个月,其中随访至6、12和18个月时恢复的患者分别为4例(14.29%)、6例(21.43%)和15例(53.57%),27例(96.43%)患者在3年内LVEF恢复正常。多因素logistic回归分析结果显示,病程[比值比(OR)=0.81,95%置信区间(CI):0.70~0.95,P<0.05]、心电图QRS波时限(OR=0.88,95%CI:0.79~0.98,P<0.05)、LVEF(OR=1.26,95%CI:1.13~1.42,P<0.01)、左室舒张末期内径(LVEDD,OR=0.79,95%CI:0.66~0.90,P<0.01)是LVEF恢复正常的独立预测因素。结论:部分CKD患者经抗心力衰竭治疗后,LVEF可恢复正常。病程较短、心电图QRS波时限较短、基线LVEF较高及LVEDD较小的患者LVEF恢复正常的可能性较大。Objective To explore the predictors of recovery of normal left ventricular ejection fraction(LVEF)in patients with chronic Keshan disease(CKD)after standard anti-heart failure treatment.Methods From June 2013 to October 2017,CKD patients were selected as the research subjects in 8 Keshan disease counties(cities)in Shandong Province.Demographic data and clinical indicators related to the recovery of normal LVEF were collected at the initial diagnosis,and the patients were given standard anti-heart failure treatment.Follow-up was carried out until October 2019 or until all-cause death.Patients were divided into recovery group and non-recovery group according to whether LVEF returned to normal(LVEF≥50%was normal)by group design,and multi-factor logistic regression was used to analyze the predictors of recovery of normal LVEF.Results A total of 98 CKD patients were included in this study,their average age was(47.51±12.84)years old;body mass index(BMI)was(23.18±4.92)kg/m2;LVEF was(39.54±8.26)%;male accounted for 65.31%(64/98);the New York Heart Association(NYHA)heart function gradeⅡand gradeⅢaccounted for 46.94%(46/98)and 53.06%(52/98),respectively.The median follow-up time was 26 months,the LVEF of 28 patients(28.57%)returned to normal,and the LVEF increased from(43.27±7.85)%of the baseline to(58.74±6.07)%,the difference was statistically significant(t=8.25,P<0.01);LVEF did not return to normal in 70 patients(71.43%),and the LVEF increased from(37.84±6.93)%of the baseline to(42.94±7.31)%,the difference was statistically significant(t=4.24,P<0.01).The median recovery time of 28 patients with normal LVEF recovery was 14 months,of which 4 patients(14.29%),6 patients(21.43%)and 15 patients(53.57%)recovered at follow-up of 6,12 and 18 months,respectively,and 27 patients(96.43%)recovered within 3 years.The results of multivariate logistic regression analysis showed that disease course[odds ratio(OR)=0.81,95%confidence interval(CI):0.70-0.95,P<0.05],electrocardiogram QRS wave duration(OR=0.88,95%CI:0.79-0.98,P<

关 键 词：心室功能 克山病 左室射血分数 超声心动描记术 超声心动图 心电图描记术 预测因素 

分 类 号：R542.3[医药卫生—心血管疾病]