中国先天性心脏病合并心力衰竭患病负担与临床现况调查分析  

Disease burden and clinical status of congenital heart disease combined with heart failure in China:a survey and analysis

作　　者：盛子贤 袁宇星 王芳洁 陈智[3] 郭颖[4] 沈兴 梁雪村 刘玲娟[1] 李佳锦 闫小莉 潘博[1] 田杰[1] Sheng Zixian;Yuan Yuxing;Wang Fangjie;Chen Zhi;Guo Ying;Shen Xing;Liang Xuecun;Liu Lingjuan;Li Jiajin;Yan Xiaoli;Pan Bo;Tian Jie(Department of Cardiology,Children′s Hospital of Chongqing Medical University,National Clinical Research Center for Child Health and Disorders,China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Key Laboratory of Children′s Important Organ Development and Diseases of Chongqing Municipal Health Commission,National Clinical Key Cardiovascular Specialty,Chongqing 400014,China;Department of Cardiology,Children′s Hospital Affiliated to Zhengzhou University,Henan Children's Hospital,Zhengzhou Children's Hospital,Zhengzhou 450018,China;Department of Cardiology,Hunan Children′s Hospital,Changsha 410007,China;Department of Cardiology,Shanghai Children′s Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of Pediatrics,Affiliated Hospital of Southwest Medical University,Clinical Research Center for Birth Defects of Sichuan Province,Luzhou 646000,China;Pediatric Heart Center,Children′s Hospital of Fudan University,National Children′s Medical Center,Shanghai 201102,China)

机构地区：[1]重庆医科大学附属儿童医院心血管内科、国家儿童健康与疾病临床医学研究中心、儿童发育重大疾病国家国际科技合作基地、重庆市卫生健康委儿童重要器官发育与疾病重点实验室、国家临床重点心血管专科,重庆400014 [2]郑州大学附属儿童医院、河南省儿童医院郑州儿童医院心血管内科,郑州450018 [3]湖南省儿童医院心血管内科,长沙410007 [4]上海交通大学医学院附属上海儿童医学中心心内科,上海200127 [5]西南医科大学附属医院儿科、四川省出生缺陷临床研究中心,泸州646000 [6]国家儿童医学中心、复旦大学附属儿科医院心血管中心,上海201102

出　　处：《中华儿科杂志》2025年第2期148-156,共9页Chinese Journal of Pediatrics

基　　金：国家儿童健康与疾病临床医学研究中心临床医学研究重点项目(NCRCCHD-2021-KP-01)。

摘　　要：目的探讨中国先天性心脏病(简称先心病)合并心力衰竭的患病负担、临床现况及影响院内结局的危险因素。方法(1)描述性研究:基于全球疾病负担2021年研究,采集1990至2021年中国<15岁先心病合并心力衰竭患儿的可用数据,并在年龄亚组(<1岁、1~<2岁、2~<5岁、5~<10岁、10~<15岁)中分析患病例数、患病率及其变化趋势,并通过回归计算年度百分比变化估计值(EAPC)。(2)回顾性队列研究:纳入中国儿童心力衰竭多中心研究中1062例先心病合并心力衰竭患儿,根据年龄分为<2岁和2~<18岁组,分析患儿基本特征、临床表现、诊断和治疗情况及院内结局(院内死亡及心血管不良事件),组间比较采用Mann-WhitneyU检验和χ^(2)检验,通过Logistic回归分析影响院内结局的危险因素。结果(1)1990至2021年中国先心病合并心力衰竭患儿的患病例数从33.3[95%不确定区间(UI)27.1~40.5]万例上升至36.8(95%UI 29.6~45.9)万例,增长了10.8%(95%UI 5.0%~16.6%);同期患病率从104.5(95%UI 85.1~127.3)/10万增加至142.0(95%UI 114.0~176.8)/10万,增长了35.9%(95%UI 28.7%~43.0%),EAPC为1.5%(95%CI 1.2%~1.8%);尽管<1岁和1~<2岁组的患病例数分别下降了41.0%和25.6%,但所有年龄组的患病率均呈上升趋势[<1岁组EAPC为0.6%(95%CI 0.5%~0.7%);1~<2岁组EAPC为0.9%(95%CI 0.8%~1.0%);2~<5岁组EAPC为1.2%(95%CI 1.0%~1.4%);5~<10岁组EAPC为1.5%(95%CI 1.2%~1.8%);10~<15岁组EAPC为2.1%(95%CI 1.9%~2.3%)]。(2)多中心研究显示,1062例住院患儿中男528例(49.7%),女534例(50.3%),入院年龄为5.4(2.2,18.2)月龄,<2岁组827例(77.9%),2~<18岁组235例(22.1%)。复合畸形的患儿516例(48.6%),单纯先心病患儿占335例(31.5%)。两年龄组患儿在人口统计学、临床表现、诊断、治疗和结局等多个变量差异均有统计学意义(均P<0.05)。肾素-血管紧张素-醛固酮系统抑制剂(41.1%,436/1062)和β受体阻滞剂(8.7%,92/1062)在先心病合并心力衰竭住院患儿中的使用率较低。LogiObjective To investigate the disease burden,clinical characteristics and independent risk factors affecting in-hospital outcomes of children with congenital heart disease(CHD)combined with heart failure(HF)in China.Methods(1)Descriptive study:based on the global burden of disease study 2021,available data on children under 15 years of age with CHD and HF in China from 1990 to 2021 were collected.The prevalence and trends in different age subgroups(<1 year,1-<2 years,2-<5 years,5-<10 years,10-<15 years)were analyzed,and the annual percentage change(EAPC)was estimated using linear regression.(2)Retrospective cohort study:a total of 1062 children with CHD and HF from a multicenter study on pediatric HF in China were included.The children were divided into two groups:<2 years group and 2-<18 years group.Data on demographics,clinical features,diagnosis,treatments,and in-hospital outcomes were analyzed.Mann-Whitney U test and chi-square test were used for group comparisons.Multivariable Logistic regression was applied to identify factors influencing outcomes(in-hospital mortality and adverse cardiovascular events).Results(1)From 1990 to 2021,the number of children with CHD and HF in China increased from 333000(95%uncertainty interval(UI)271000-405000)to 368000(95%UI 296000-459000),a growth of 10.8%(95%UI 5.0%-16.6%).Concurrently the prevalence rate increased from 104.5(95%UI 85.1-127.3)per 100000 to 142.0(95%UI 114.0-176.8)per 100000,a growth of 35.9%(95%UI 28.7%-43.0%),with an EAPC of 1.5%(95%CI 1.2%-1.8%).Although the number of cases in the<1 year and 1-<2 years groups decreased by 41.0%and 25.6%,respectively,the prevalence in all age groups showed an upward trend:<1 year EAPC 0.6%(95%CI 0.5%-0.7%);1-<2 years EAPC 0.9%(95%CI 0.8%-1.0%);2-<5 years EAPC 1.2%(95%CI 1.0%-1.4%);5-<10 years EAPC 1.5%(95%CI 1.2%-1.8%);10-<15 years EAPC 2.1%(95%CI 1.9%-2.3%).(2)The multicenter study revealed that among 1062 hospitalized children,528(49.7%)were male and 534(50.3%)were female,with the age at admission of 5.4(2.2,18.2)months.Th

关 键 词：心脏缺损 先天性 心力衰竭 儿童 患病率 

分 类 号：R541.1[医药卫生—心血管疾病] R541.6[医药卫生—内科学]