扩张型心肌病患者长期预后及危险因素分析  

Analysis of long-term prognosis and risk factors in patients with dilated cardiomyopathy

作　　者：张舒媛 高仕奇 王泽源 吴铭 田庄 张抒扬[1] Zhang Shuyuan;Gao Shiqi;Wang Zeyuan;Wu Ming;Tian Zhuang;Zhang Shuyang(Department of Cardiology,State Key Laboratory of Severe and Rare Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院心内科,疑难重症及罕见病国家重点实验室,北京100730

出　　处：《中华心血管病杂志》2024年第4期384-390,共7页Chinese Journal of Cardiology

基　　金：雄安新区科技创新专项(2023XAGG0069);国家高水平医院临床研究基金(2022-PUMCH-B-098,2022-PUMCH-D-002)。

摘　　要：目的探讨扩张型心肌病(DCM)患者发生主要不良心血管事件的危险因素和长期预后情况。方法该研究为单中心回顾性队列研究,纳入2013年4月至2023年4月在北京协和医院住院的300例DCM患者,收集患者基本临床资料,并基于超声心动图检查结果将患者分为2组:孤立型DCM和DCM伴左心室心肌致密化不全(LVNC)。通过门诊或电话进行随访,记录患者发生的主要不良心血管事件,包括主要心力衰竭(心衰)事件、严重室性心律失常和心血管死亡。采用单因素和多因素Cox比例风险回归模型分析影响DCM患者预后的相关危险因素,生存分析采用Kaplan-Meier曲线,采用log-rank比较2组患者主要不良心血管事件发生率的差异。结果纳入的300例DCM患者年龄为(47.8±16.8)岁,男性197例(65.7%),其中237例(79.0%)为孤立型DCM,63例(21.0%)为DCM伴LVNC。随访时间为4.0(1.9,6.2)年,共142例(47.3%)发生主要不良心血管事件,其中主要心衰事件有117例(39.0%),严重室性心律失常有20例(6.7%),心血管死亡有53例(17.7%)。多因素Cox比例风险回归模型分析显示,左心室舒张末期内径增加(HR=1.21,95%CI:1.01~1.44,P=0.042),中或重度二尖瓣反流(HR=1.71,95%CI:1.19~2.47,P=0.004),ln(N末端B型利钠肽原)升高(HR=1.30,95%CI:1.10~1.54,P=0.002)是DCM患者发生主要不良心血管事件的独立危险因素,血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体拮抗剂(ARB)/血管紧张素受体脑啡肽酶抑制剂(ARNI)治疗(HR=0.45,95%CI:0.26~0.78,P=0.004)是其独立保护因素。Kaplan-Meier生存分析显示孤立型DCM和DCM伴LVNC患者发生主要不良心血管事件的风险差异无统计学意义(log rank P=0.22)。同样,2组患者主要心衰、严重室性心律失常、心血管死亡等事件的发生率差异均无统计学意义(P均>0.05)。结论左心室舒张末期内径增加、中或重度二尖瓣反流、N末端B型利钠肽原升高、未服用ACEI/ARB/ARNI是DCM患者发生主要不良心�Objective To investigate the risk factors and long-term prognosis of major adverse cardiovascular events(MACEs)in patients with dilated cardiomyopathy(DCM).Methods This study was a single-center retrospective cohort study.Clinical information from 300 patients with DCM hospitalized in Peking Union Medical College Hospital from April 2013 to April 2023 was collected.Based on echocardiography results,the patients were divided into two groups:isolated DCM and DCM with left ventricular non-compaction cardiomyopathy(LVNC).The MACEs,including major heart failure events,severe ventricular arrhythmias,and cardiovascular death,were recorded by outpatient or telephone follow-up.Univariate and multivariate Cox proportional hazard regression models were used to analyze the risk factors affecting the prognosis of patients with DCM.Kaplan-Meier curve and log-rank were used for survival analysis to compare the difference in the incidence of cardiovascular events between the two groups.Results The included 300 DCM patients were(47.8±16.8)years old,with 197 males(65.7%),of which 237(79.0%)were isolated DCM and 63(21.0%)were DCM with LVNC.The follow-up time was 4.0(1.9,6.2)years.A total of 142(47.3%)MACEs occurred,including 117(39.0%)major heart failure events,20(6.7%)severe ventricular arrhythmia events,and 53(17.7%)cardiovascular death events.Multivariate Cox proportional hazard regression analysis showed that increased left ventricular end-diastolic diameter(HR=1.21,95%CI:1.01-1.44,P=0.042),moderate or severe mitral regurgitation(HR=1.71,95%CI:1.19-2.47,P=0.004),increased ln(N-terminal pro-B-type natriuretic peptide)(HR=1.30,95%CI:1.10-1.54,P=0.002)were independent risk factors for dverse cardiovascular events in DCM patients,and angiotensin-converting enzyme inhibitor(ACEI)/angiotensin receptor blocker(ARB)/angiotensin receptor neprilysin inhibitor(ARNI)treatment(HR=0.45,95%CI:0.26-0.78,P=0.004)was independent protective factor.Kaplan-Meier survival analysis found no significant difference in the risk of MACEs between isolate

关 键 词：心肌病 扩张型 心肌致密化不全 危险因素 心血管事件 

分 类 号：R542.2[医药卫生—心血管疾病]