中国社区35岁及以上成人瓣膜性心脏病患者的远期死亡风险

Long-term mortality risk of valvular heart disease adults over 35 years old in Chinese communities

目的探讨中国社区35岁及以上成人瓣膜性心脏病(VHD)患者的远期死亡风险及其影响因素。方法本研究为队列研究。基于2012—2015年中国高血压调查和2018—2019年的随访研究数据,纳入基线资料中包含超声心动图检查的调查对象,采用Kaplan-Meier曲线进行生存分析并行log-rank检验,采用Cox回归模型分析全因死亡和心血管疾病(CVD)死亡的影响因素。结果调查对象随访(4.6±0.9)年,共纳入东部5个、中部5个、西部4个省市自治区的23237名研究对象,男10881名,女12356名,年龄(56.9±13.2)岁;其中患有VHD 1004例,男467例,女537例,年龄(68.1±12.6)岁。Kaplan-Meier生存分析结果显示,相较于无VHD人群,VHD患者全因死亡风险(log-rankχ^(2)=351.82,P<0.001)、CVD死亡风险(log-rankχ^(2)=284.14,P<0.001)均增加。Cox回归分析结果显示,与无VHD人群比较,风湿性VHD患者的全因死亡风险增加45%(HR=1.45,95%CI:1.12~1.89);退行性VHD患者的CVD死亡风险增加69%(HR=1.69,95%CI:1.19~2.38)。基线年龄55岁及以上(55~<75岁:HR=4.93,95%CI:1.17~20.85;≥75岁:HR=11.92,95%CI:2.85~49.80)、合并糖尿病(HR=1.71,95%CI:1.00~2.93)是VHD患者CVD死亡的危险因素。结论VHD会增加35岁及以上成人全因死亡和CVD死亡风险。55岁及以上、合并糖尿病是VHD患者预后不良的危险因素。

Objective To investigate the risk and influencing factors of long-term mortality of valvular heart disease(VHD)adults aged 35 years and over in Chinese communities.Methods A cohort study was carried out.The data of the subjects who underwent echocardiography were collected from the Chinese Hypertension Survey between 2012 and 2015 and survival outcomes were followed up between 2018 and 2019.Kaplan-Meier survival curves were plotted and compared using log-rank test.Cox proportional hazards models were used to analyze the influence of VHD on mortality.Results During an average follow-up time of(4.6±0.9)years,a total of 23237 participants(10881 males and 12356 females)were pooled into the final analysis from 5 eastern,5 central,and 4 western provinces,cities and autonomous regions in China,with a mean age of(56.9±13.2)years.Among the included participants,1004 had VHD(467 males and 537 females),with a mean age was of(68.1±12.6)years.In the Kaplan-Meier analysis,participants with VHD had a significantly increased risk of all-cause mortality(log-rankχ^(2)=351.82,P<0.001)and cardiovascular mortality(log-rankχ^(2)=284.14,P<0.001)compared with those without VHD.Multivariate Cox regression analysis showed that compared with those without VHD,the participants with rheumatic VHD had a 45%increased risk of all-cause mortality(HR=1.45,95%CI:1.12-1.89)and degenerative VHD increased the risk of cardiovascular mortality by 69%(HR=1.69,95%CI:1.19-2.38).The risk factors of cardiovascular mortality for VHD were age 55 years and over(55-<75 years:HR=4.93,95%CI:1.17-20.85;≥75 years:HR=11.92,95%CI:2.85-49.80)and diabetes mellitus(HR=1.71,95%CI:1.00-2.93).Conclusions VHD is a risk factor of all-cause mortality and cardiovascular mortality among adults aged 35 years and over.Age 55 years and over and diabetes mellitus are adverse prognostic factors for patients with VHD.