不同左心室射血分数心力衰竭患者的健康相关生活质量变化趋势及差异分析  

Differences and Trends in Health-Related Quality of Life in Hospitalized Patients for Heart Failure With Preserved,Mildly Reduced and Reduced Left Ventricular Ejection Fraction

作　　者：蒲博轩 赫广达 季润青 于炎武 李艳 苏小茗 雷璐碧 李京阔 张丽华 PU Boxuan;HE Guangda;JI Runqing;YU Yanwu;LI Yan;SU Xiaoming;LEI Lubi;LI Jingkuo;ZHANG Lihua(National Clinical Research Center for Cardiovascular Diseases,National Center for Cardiovascular Diseases and Fuwai Hospital,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、阜外医院、国家心血管疾病临床医学研究中心,北京100037

出　　处：《中国循环杂志》2023年第6期656-662,共7页Chinese Circulation Journal

基　　金：国家科技部国家重点研发计划(2018YFC1312400、2018YFC1312401);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(2021-I2M-1-007)。

摘　　要：目的:分析不同左心室射血分数(LVEF)心力衰竭(心衰)患者的健康相关生活质量(HRQoL)变化趋势及差异。方法:基于重大慢病国家注册登记研究心衰前瞻性队列连续入选2016年8月至2018年5月全国52家医院≥18岁、因急性心衰入院的2222例患者,均完成入院48 h内及出院1个月、6个月、1年随访时堪萨斯城心肌病问卷-12(KCCQ-12)调查。纳入患者按LVEF分为射血分数降低的心衰(HFrEF,LVEF<40%)、射血分数轻度降低的心衰(HFmrEF,40%≤LVEF<50%)和射血分数保留的心衰(HFpEF,LVEF≥50%),采用KCCQ-12评分定量评估三类心衰患者的HRQoL。结果:2222例心衰住院患者的中位年龄65(55,74)岁,36.3%为女性,HFrEF患者942例(42.4%),HFmrEF患者470例(21.2%),HFpEF患者810例(36.5%)。与HFrEF患者相比,HFmrEF、HFpEF患者的年龄较大,女性比例较高(P均<0.017);HFmrEF、HFpEF患者中合并高血压、冠心病、心房颤动、贫血的患者比例均高于HFrEF患者(P均<0.017)。与基线相比,三类心衰患者出院1个月、6个月、1年时的KCCQ-12评分均增加(P均<0.01),且KCCQ-12评分随时间变化趋势相似,均在1个月时大幅度增加,在6个月时小幅度增加,此后6个月趋于稳定;HFpEF患者出院1个月、6个月、1年时的KCCQ-12评分均低于HFrEF、HFmrEF患者,HFmrEF患者的KCCQ-12评分低于HFrEF患者,差异均有统计学意义(P均<0.01)。多因素Logistic回归分析显示,合并高血压、慢性肾脏病、HFpEF、NYHA心功能分级Ⅲ级和Ⅳ级的患者出院后1年HRQoL差的可能性更大(P均<0.05)。结论:HFpEF患者年龄较大,合并症较多。在出院后1年存活的患者中,HFrEF、HFmrEF、HFpEF患者的HRQoL均在1个月随访时较基线明显改善,6个月小幅度改善,然后趋于稳定;出院后,HFrEF患者的HRQoL相对较好,HFpEF患者较差,HFmrEF患者介于两者之间。Objectives:To analyze the differences in health-related quality of life(HRQoL)and its trends over time in patients hospitalized for heart failure with preserved,mildly reduced and reduced left ventricular ejection fractions(LVEF).Methods:Data 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 consecutively enrolled from 52 hospitals in China from August 2016 to May 2018.Patients who completed the Kansas City Cardiomyopathy Questionnaire-12(KCCQ-12)at baseline,1,6,and 12 months were selected and categorized into three groups according to LVEF:heart failure with reduced ejection fraction(HFrEF,LVEF<40%),heart failure with mildly reduced ejection fraction(HFmrEF,40%≤LVEF<50%)and heart failure with preserved ejection fraction(HFpEF,LVEF≥50%).Differences in HRQoL based on KCCQ-12 and their trends over time were compared among the three groups.Results:A total of 2222 patients with heart failure were enrolled,with a median age of 65(55,74)years and 36.3%were female.There were 942(42.4%)patients in the HFrEF group,470(21.2%)in the HFmrEF group,and 810 in the HFpEF(36.5%)group.The median age and proportion of female were higher in the HFpEF group than in the HFmrEF and HFrEF groups(all P<0.017).The proportion of patients with a history of hypertension,coronary artery disease,atrial fibrillation,or anemia were higher in the HFmrEF and HFpEF groups than in the HFrEF group(all P<0.017).Compared with baseline,KCCQ-12 scores in HFrEF,HFmrEF and HFpEF groups increased at each follow-up time point(P<0.01).The trend of KCCQ-12 scores over time was similar in the three groups,showing a large improvement in the 1 month,a small improvement in the 6 month,and a stable trend in the following six months post discharge.The KCCQ-12 scores in HFpEF were lower than those in HFrEF and HFmrEF groups at the 1,6 and 12 months post discharge.The KCCQ-12 scores in HFmrEF group were also lower than

关 键 词：心力衰竭 左心室射血分数 健康相关生活质量 堪萨斯城心肌病问卷-12 

分 类 号：R54[医药卫生—心血管疾病]