高龄重度主动脉瓣狭窄患者的远期预后及危险因素分析  

Long-term Prognosis and Risk Factors of Worse Outcome in Elderly Patients With Aortic Stenosis

作　　者：李秋忆 陈可冀[2] 赵振燕[3] 叶蕴青[3] 王墨扬[3] 丰德京 刘庆荣[3] 许海燕[3] 吴永健[3] 李喆[3] LI Qiuyi;CHEN Keji;ZHAO Zhenyan;YE Yunqing;WANG Moyang;FENG Dejing;LIU Qingrong;XU Haiyan;WU Yongjian;LI Zhe(Graduate School of Beijing University of Chinese Medicine,Beijing(100029),China)

机构地区：[1]北京中医药大学研究生院,北京市100029 [2]中国中医科学院西苑医院心内科 [3]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冠心病中心

出　　处：《中国循环杂志》2022年第4期362-367,共6页Chinese Circulation Journal

基　　金：首都卫生发展科研专项重点攻关项目(首发2020-1-4031)。

摘　　要：目的:分析不同治疗策略下高龄重度主动脉瓣狭窄患者的远期预后以及死亡危险因素。方法:回顾性收集2008年1月1日至2015年1月1日年龄≥75岁在中国医学科学院阜外医院住院诊断为非风湿性主动脉瓣狭窄病变且超声心动图证实为重度主动脉瓣狭窄的207例患者的临床资料。根据治疗方案分为药物治疗组(n=91)、经导管主动脉瓣置换术(TAVR)组(n=55)及外科主动脉瓣置换术(SAVR)组(n=61)。中位随访67个月,主要研究终点为全因死亡。结果:207例患者平均年龄为(78.8±3.1)岁,药物治疗组中合并心肌梗死、心原性休克、肾功能不全、三尖瓣病变的比例较高,左心室射血分数(LVEF)较低(P均<0.05)。中位随访67个月,总全因死亡率为44.0%,药物治疗组全因死亡率明显高于TAVR组和SAVR组(三者分别为85.7%、9.1%、13.1%,P均<0.01)。多因素Cox回归分析显示,女性(HR=1.90,95%CI:1.10~3.30,P<0.05)、合并糖尿病(HR=3.20,95%CI:1.70~5.90,P<0.01)、N末端B型利钠肽原(NT-proBNP)水平升高(HR=2.90,95%CI:1.50~5.80,P<0.01)与全因死亡风险升高独立相关。体重指数(BMI)升高(HR=0.55,95%CI:0.37~0.83,P<0.01)与换瓣治疗(HR=0.03,95%CI:0.01~0.08,P<0.01)与死亡风险减低相关。结论:接受TAVR和SAVR治疗的高龄钙化性重度主动脉瓣狭窄患者远期全因死亡率均较低。女性、合并糖尿病、NT-proBNP升高是6年全因死亡的独立危险因素。Objectives:To evaluate the long-term prognosis of elderly patients with severe aortic stenosis(AS)treated with various options and risk factors related to mortality.Methods:Clinical data of patients aged≥75 years,who were diagnosed as severe non-rheumatic aortic stenosis by echocardiography in Fuwai Hospital from January 1,2008 to January 1,2015 were retrospectively collected.207 elderly patients with severe AS were included,including 91 patients in the drug therapy group,55 patients in the transcatheter aortic valve replacement(TAVR)group,and 61 patients in the surgical aortic valve replacement(SAVR)group.The median followup time was 67 months.The primary endpoint was all-cause death.Results:The average age of 207 patients was(78.8±3.1)years.In the drug treatment group,the proportion of myocardial infarction,cardiogenic shock,renal insufficiency and tricuspid valve disease was higher,and left ventricular ejection fraction(LVEF)was lower.The median follow-up time was 67 months,and the total all-cause mortality rate was 44.0%.The all-cause mortality in drug treatment group was significantly higher than that in TAVR group and SAVR group(85.7%,9.1%and 13.1%respectively,both P<0.01).Multivariate Cox regression analysis showed that female(HR=1.90,95%CI:1.10-3.30,P<0.05),diabetes mellitus(HR=3.20,95%CI:1.70-5.90,P<0.01),higher N-terminal B-type natriuretic peptide(NT-proBNP)(HR=2.90,95%CI:1.50-5.80,P<0.01)were independently associated with an increased risk of all-cause death.Increased body mass index(BMI)(HR=0.55,95%CI:0.37-0.83,P<0.01)and valve replacement(HR=0.03,95%CI:0.01-0.08,P<0.01)were associated with a reduced risk of all-cause death.Conclusions:Aortic valve replacement could significantly improve the long-term prognosis of elderly patients with severe aortic stenosis,and there is no significant difference in mortality between the TAVR group and the SAVR group.Female,diabetes mellitus,and elevated NT-proBNP are independent risk factors for all-cause death during the long-term follow up period.

关 键 词：主动脉瓣狭窄 经导管主动脉瓣置换术 高龄 预后 危险因素 

分 类 号：R54[医药卫生—心血管疾病]