不同左心室射血分数心力衰竭住院患者的临床特征、诊疗情况及结局差异  

Characteristics,Management,and Outcomes of Patients Hospitalized for Heart Failure With Preserved,Mid-range and Reduced Left Ventricular Ejection Fraction

作　　者：季润青 张丽华[1] 黄星荷 王斌[1] 白雪珂 高敏[1] 周柯 李静[1] JI Runqing;ZHANG Lihua;HUANG Xinghe;WANG Bin;BAI Xueke;GAO Min;ZHOU Ke;LI Jing(State Key Laboratory of Cardiovascular Disease,NHC Key Laboratory of Clinical Research for Cardiovascular Medications,National Clinical Research Center for Cardiovascular Diseases,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,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,阜外医院国家心血管疾病临床医学研究中心,国家卫生健康委员会心血管药物临床研究重点实验室,心血管疾病国家重点实验室,北京市100037

出　　处：《中国循环杂志》2021年第8期769-774,共6页Chinese Circulation Journal

基　　金：国家科技部国家重点研发计划(2018YFC1312400、2018YFC1312401);科技部社发司国家科技支撑计划(2015BAI12B02);中国医学科学院医学与健康科技创新工程(2016-I2M-2-004);中国医学科学院阜外医院心血管疾病国家重点实验室课题(GZ2021010);北京协和医学院研究生创新基金(2018-1002-01-12)。

摘　　要：目的:分析不同左心室射血分数(LVEF)心力衰竭(心衰)住院患者临床特征、院内诊疗及6个月结局差异。方法:从重大慢病国家注册登记研究心衰前瞻队列研究中选取2016年8月至2017年7月全国50家医院连续纳入的18岁以上心衰住院患者,根据LVEF分为射血分数减低的心衰(HFrEF,LVEF<40%)组、射血分数中间值的心衰(HFmrEF,40%≤LVEF<50%)组、射血分数保留的心衰(HFpEF,LVEF≥50%)组。比较三组患者的临床特征、院内治疗情况和6个月全因死亡风险。结果:共入选2781例心衰住院患者,中位年龄67(57,75)岁,37.9%为女性;HFrEF组1031例(37.1%),HFmrEF组643例(23.1%),HFpEF组1107例(39.8%)。HFmrEF组患者中位年龄(67岁)高于HFrEF组(62岁),但低于HFpEF组(71岁),HFpEF组的女性比例(51.4%)高于HFrEF组(23.9%)和HFmrEF组(37.3%),差异均有统计学意义(P均<0.017)。全部心衰患者中合并比例最高的疾病为高血压(56.4%)、心房颤动(29.5%)和糖尿病(28.3%)。HFmrEF组和HFpEF组高血压(HFmrEF组vs.HFpEF组vs.HFrEF组:60.5%vs.63.0%vs.46.8%)和心房颤动(HFmrEF组vs.HFpEF组vs.HFrEF组:32.2%vs.35.6%vs.21.3%)的合并比例均明显高于HFrEF组(P均<0.017)。HFmrEF组住院期间血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂、醛固酮受体拮抗剂和β受体阻滞剂的使用率分别为66.4%、85.1%、74.5%,HFpEF组分别为55.2%、76.4%、64.1%,两组均低于HFrEF组(75.8%、90.1%、81.2%,P均<0.017)。HFmrEF组(HR=0.696,95%CI:0.510~0.951,P=0.02)和HFpEF组(HR=0.493,95%CI:0.366~0.665,P<0.01)患者6个月死亡风险均低于HFrEF组患者。结论:本研究中,HFpEF患者和HFmrEF患者在全部心衰住院患者中分别占四成和近四分之一。HFpEF患者和HFmrEF患者的临床特征与HFrEF患者不同,治疗模式相似,出院6个月死亡风险均低于HFrEF患者。Objectives:To analyze the clinical characteristics,in-hospital treatment,and 6-month outcomes of patients hospitalized for heart failure with preserved,mid-range and reduced left ventricular ejection fraction(LVEF).Methods:Data for this study were obtained from the China Patient-centered Evaluative Assessment of Cardiac Events(PEACE)-Prospective Heart Failure Study.Patients aged 18 years or older and hospitalized for heart failure were enrolled from 50 hospitals in China from August 2016 to July 2017.The patients were categorized into three groups according to their LVEF:heart failure with reduced ejection fraction(HFrEF,LVEF<40%),heart failure with mid-range ejection fraction(HFmrEF,40%≤LVEF<50%),and heart failure with preserved ejection fraction(HFpEF,LVEF≥50%).The clinical characteristics,in-hospital management,and 6-month all-cause mortality were compared among the groups.Results:The study included 2781 patients;the median age was 67(57,75)years and 37.9%were women.There were 1031 patients(37.1%)in HFrEF group,643(23.1%)in HFmrEF group,and 1107(39.8%)in HFpEF group.The median age of HFmrEF group(67 years)was higher than that of HFrEF group(62 years)but was lower than that of HFpEF group(71 years),both P<0.017.The proportion of women was the highest in HFpEF group(51.4%)among the three groups(HFrEF group 23.9%,HFmrEF group 37.3%,blth P<0.017).In all patients,the main complications of heart failure included hypertension(56.4%),atrial fibrillation(29.5%),and diabetes mellitus(28.3%).The proportion of hypertension and atrial fibrillation was higher in HFmrEF group(60.5%,32.2%)and in HFpEF group(63.0%,35.6%)than in HFrEF group(46.8%,21.3%,all P<0.017).Hospital utilizations of angiotensin converting enzyme inhibitor/angiotensin receptor blockers,aldosterone receptor antagonist,and beta blockers were lower in HFmrEF group(66.4%,85.1%,74.5%)and HFpEF group(55.2%,76.4%,64.1%)than in HFrEF group(75.8%,90.1%,81.2%),all P<0.017.Risk of 6-month death was lower in patients with HFmrEF(HR=0.696,95%CI:0.510-0.951,P=0.02)

关 键 词：心力衰竭 左心室射血分数 临床特征 院内管理 结局 

分 类 号：R54[医药卫生—心血管疾病]