不同心脏疾病所致慢性收缩性心力衰竭患者预后的比较

于胜波; 崔红营; 秦牧; 刘韬; 孔彬; 赵庆彦; 黄鹤; 黄从新

文章摘要

于胜波,崔红营,秦牧,刘韬,孔彬,赵庆彦,黄鹤,黄从新.不同心脏疾病所致慢性收缩性心力衰竭患者预后的比较[J].中华流行病学杂志,2011,32(11):1148-1152

不同心脏疾病所致慢性收缩性心力衰竭患者预后的比较

The prognostic value of etiology in patients with chronic systolic heart failure

收稿日期:2011-05-27 出版日期:2014-09-18

DOI：

中文关键词: 心力衰竭病因学预后

英文关键词: nic systolic heart failure Etiology Prognosis

基金项目:国家自然科学基金(30972433)；“十一五”国家科技支撑计划(2007BAcl6807)

作者	单位	E-mail
于胜波	武汉大学人民医院心内科 430060	huangcongxin@yaboo.com.cn
崔红营	武汉大学人民医院心内科 430060
秦牧	武汉大学人民医院心内科 430060
刘韬	武汉大学人民医院心内科 430060
孔彬	武汉大学人民医院心内科 430060
赵庆彦	武汉大学人民医院心内科 430060
黄鹤	武汉大学人民医院心内科 430060
黄从新	武汉大学人民医院心内科 430060

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中文摘要:

目的探讨病因对慢性收缩性心力衰竭（心衰）患者预后影响。方法回顾性分析湖北地区16 681例心衰住院患者临床资料，所有患者电话随访。Cox比例风险模型评价不同病因患者预后差异并构建Kaplan-Meier曲线。Cox生存分析评价心衰患者预后危险因素。多元logistic回归分析构建ROC曲线。结果 (1)随访3(2～4)年，冠心病(CHD)、扩张型心肌病(DCM)、高血压性心脏病(HHD)和风湿性心瓣膜病(RHD)总死亡率、心脏泵衰竭死亡和心源性猝死分别为34.50%、54.30%、41.48%和15.76%；30.11%、44.95%、36.25%和13.10%；8.46%、8.45%、9.84%和1.05%。(2)以RHD为参照，CHD、DCM和HHD总死亡、心脏泵衰竭死亡和心源性猝死风险分别为1.554 (P＜0.001)、1.405(P=0.003)和1.315 (P=0.005)；1.458 (P＜0.001)、1.763 (P＜0.001)和1.281(P=0.008)3.345(P=0.013)、4.764(P=0.002)和2.062(P=0.137)。(3)病因增加最佳预测模型预测总死亡和心脏泵衰竭死亡的ROC曲线下面积分别为[0.839 (95% CI: 0.832～0.845)vs.0.776(95%CI:0.768～0.784)]和[0.814(95%CI: 0.806～0.822)vs.0.796(95%CI:0.788～0.804)]。结论病因对慢性收缩性心衰患者预后存在显著性影响。

英文摘要:

Objective To determinate the prognostic value of etiology in patients with chronic systolic heart failure (CSHF).Methods Data of in-hospital patients with CSHF were investigated between 2000 and 2010 from 12 hospitals in Hubei province.All patients were followed up through telephone calls.Univariate and multivariate Cox proportional hazards analyses were then used to explore the differences in the all-cause mortality,heart failure (HF) mortality and sudden cardiac death (SCD) among patients caused by different etiologies.Kaplan-Meier curve were then constructed and Univariate and multivariate Cox regression analyses were used to select demographic and clinical variables in predicting the all-cause mortality,HF mortality and SCD in CSHF patients.Multivariate logistic models and ROC curve were developed with or without the cinfirmed etiology to assess the incremental additive information related to different etiologies.Results (1)Over the median 3 (2-4) years follow-up program,6453 (38.69%) patients died,including 5505 (33.00%) due to HF prognosis and 717 (4.30%) died of SCD.All-cause mortality rates accounted for 34.50%,54.30%,41.48% and 15.76%,with HF mortality rates as 30.11%,44.95%,36.25% and 13.10%.SCDs accounted 8.46%,8.45%,9.84% and 1.05% in patients with CHD,DCM,HHD and RHD,respectively.(2) Compared with RHD patients,the adjusted HRs for all-cause mortality were 1.554 (1.240 to 1.947;P＜0.001),1.405(1.119 to 1.764;P=0.003) and 1.315(1.147 to 1.467;P=0.005) while the adjusted HRs and 95%CIs for HF mortality were 1.458( 1.213-1.751;P＜0.001 ),1.763( 1.448-2.147;P＜0.001 ) and 1.281 (1.067-1.537; P=0.008),in patients with CHD, DCM and HHD,respectively.There were no significant differences in CHD (HR 3.345;95% CI,1.291 to 8.666;P=0.013) or HHD (HR 2.062;95%CI,0.794 to 5.352;P=0.137),while only DCM ( HR 4.764;95%CI,1.799 to 12.618;P=0.002) remained significant in SCD despite of the multivariate adjustment.(3) Etiology increased the sensitivity andspecificity ofpredicting models forall-cause mortality(AUC 0.839,95%CI,0.832to 0.845 vs.0.776,95% CI,0.768 to 0.784) andHFmortality(AUC 0.814,95%CI,0.806 to0.822 vs.0.796,95%CI,0.788 to 0.804) but not with SCD (AUC 0.777,95%CI,0.749 to 0.809 vs.0.747,95%CI,0.727 to 0.766).Conclusion

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