慢性心力衰竭患者年龄及性别与心脏再同步化疗效的关系

Correlations of age and gender with the effects of cardiac resynchronization therapy in chronic heart failure patients

目的影响慢性心力衰竭患者心脏再同步化治疗/心脏再同步化并植入心脏复律除颤器（cardiac resynchronization therapy or cardiac resynchronization and implantable cardioverter-defibrilator CRT/CRTD）因素较多。文中旨在探讨不同年龄、性别与慢性心力衰竭患者CRT/CRTD疗效之间关系。方法收集2005年1月至2015年3月在南京医科大学第一附属医院接受CRT/CRTD治疗的136例慢性心力衰竭患者。按年龄分为3组：老年组（〉70岁,n=29）、中年组（50~70岁,n=77）与青年组（〈50岁,n=30）;按性别分为：男性组（n=92）和女性组（n=44）。分别比较不同年龄及性别组间CRT术前基线、术后6个月CRT反应率及全因死亡率。以术后6个月纽约心功能分级（New York Heart Association,NYHA）降低≥1级、左心室射血分数提高≥5%定义为CRT有反应。结果 136例患者中,CRT有反应者72例,有反应率53%。不同年龄组术后CRT有反应率分别为：老年组52%、中年组55%、青年组50%,组间比较差异无统计学意义（P〉0.05）。女性组较男性组CRT有反应率高,差异有统计学意义（66%vs 47%,P=0.027）。Cox多因素分析及Kaplan-Meier分析显示,不同年龄组和男女性别组的全因死亡率比较,差异无统计学意义（P〉0.05）;Logistic多因素回归分析显示,左心室舒张末期内径及基线QRS时限是术后6个月CRT有反应的预测因子。结论慢性心衰患者年龄对其行CRT的疗效无影响;女性CRT有反应率常高于男性。

Objective Various factors may affect the effects of cardiac resynchronization therapy or cardiac resynchronization and implantable cardioverter-defibrilator（ CRT / CRTD） in chronic heart failure patients（ CHF）. The aim of our study was to explore the correlation of age and gender with the effects of CRT / CRTD in chronic heart failure patients. Methods This study included 136 CHF patients,92 males and 44 females,treated by CRT / CRTD from January 2005 to March 2015. We divided the patients into three age groups： ≥70 yr（ n = 29）,50- 70 yr（ n = 77）,and 50 yr（ n = 30）,and compared the baseline characteristics,CRT responding rate and all-cause mortality among different groups. The CRT response was defined as the decrease of NYHA cardiac function ≥1 grade and left ventricular ejection fraction（ LVEF） improvement ≥5%. Results In the 136 CHF patients,there were 72 CRT responders（ 53%）,52% in the ≥70 yr group,55% in the 50- 70 yr group,and 50% in the 50 yr group,with no statistically significant differences among the three groups（ P 0. 05）. However,the CRT responding rate was remarkably higher in the female than in the male patients（ 66% vs 47%,P = 0. 027）. Cox multivariate and Kaplan-Meier analyses revealed no significant differences in all-cause mortality between different genders or age groups. Multivariate logistic regression analysis showed that the left ventricular diastolic diameter and base QRS duration were independent factors of the CRT response.Conclusion Age does not affect the CRT response in chronic heart failure patients,while female patients have a higher CRT responding rate than male patients.