摘要
目的 探讨扩张型心肌病(DCM)伴心力衰竭(心衰)的住院患者出院后死亡的影响因素。方法 入选北京协和医院病案室数据库中2016年1月至2021年6月在心内科住院并完成随访的DCM伴心衰患者173例,收集患者住院的各项临床资料,并进行电话或门诊随访,获得终点事件(全因死亡)。结果 中位随访时间为47(35,57)个月,死亡组(35例,20.2%)患者的年龄、纽约心脏病协会(NYHA)心功能Ⅲ~Ⅳ级比例、NYHA心功能分级、N末端B型利钠肽原、血肌酐、肺动脉收缩压升高比例、慢性肾脏病比例、心房颤动比例和华法林使用率均高于非死亡组(均为P<0.05),而左室射血分数、血压、估测的肾小球滤过率、血白蛋白、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂使用率、β受体阻滞剂使用率和血管紧张素受体脑啡肽酶抑制剂使用率均低于非死亡组(均为P<0.05)。多变量logistic回归分析结果显示,年龄(OR=1.034,P=0.023)、肺动脉高压(OR=3.717,P=0.011)和入院收缩压<100 mmHg(OR=4.257,P=0.018)与DCM患者的死亡风险增高有关,而β受体阻滞剂的应用(OR=0.161,P=0.033)是改善DCM患者预后的因素。结论 年龄、肺动脉高压、收缩压<100 mmHg、β受体阻滞剂使用是DCM伴心衰患者出院后死亡的部分影响因素。
Objective To explore the influential factors of all-cause death after discharge in hospitalized patients with dilated cardiomyopathy(DCM) complicated with heart failure(HF).Methods A total of 173 patients diagnosed with DCM complicated with HF at Peking Union Medical College Hospital between January,2016 to June,2021 were enrolled.The clinical data was collected and analyzed.The endpoint event(all-cause death) was determined based on follow-up information.Results The median follow-up period was 47(35,57) months.The age,New York Heart Association(NYHA) class,the rate of NYHA Ⅲ-Ⅳ,N-terminal pro-B-type natriuretic peptide,serum creatinine,pulmonary hypertension(PH),chronic kidney diseases,atrial fibrillation and the treatment rate of warfarin were higher in the death group(n=35,20.2%) than in the nondeath group(all P<0.05).Left ventricular ejection fraction,blood pressure,estimated glomerular filtration rate,serum albumin were lower in the death group than in the nondeath group(all P<0.05).β-blocker,angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker and angiotensin receptor-neprilysin inhibitor were less frequently used in the death group than in the nondeath group(all P<0.05).By multivariable analysis,age(OR=1.034,P=0.023),PH(OR=3.717,P=0.011) and systolic blood pressure(SBP) <100 mmHg(OR=4.257,P=0.018) were associated with increased risk of death,and the β-blocker(OR=0.161,P=0.033) was associated with the decreased risk of death.Conclusions Age,PH,SBP <100 mmHg and use of β-blocker were influencing factors for death after discharge in patients with DCM and HF.
作者
扎西卓玛
王吴婉
林雪
陈未
方理刚
Zha Xizhuoma;Wang Wuwan;Lin Xue;Chen Wei;Fang Ligang(Department of Cardiology,State Key Laboratory of Complex Severe and Rare Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100730,China)
出处
《中国心血管杂志》
2022年第2期123-128,共6页
Chinese Journal of Cardiovascular Medicine
基金
中国医学科学院医学与健康科技创新工程(2019-I2M-2-003)。
关键词
心肌病
扩张型
心力衰竭
随访
预后
Cardiomyopathy,dilated
Heart failure
Follow-up
Prognosis
