老年退行性心脏瓣膜病病人临床特点和预后的性别差异分析

Analysis of Gender Differences in Clinical Features and Prognosis of Senile Patients with Degenerative Valve Heart Disease

目的探讨老年退行性心脏瓣膜病病人临床特点和预后的性别差异。方法纳入中国老年瓣膜性心脏病住院病人(China-DVD)注册登记研究中2016年9月—2016年12月在全国69家医院连续入选60岁以上的中重度退行性心脏瓣膜病住院病人2728例,收集病人基线资料并随访1年,比较两组疾病分布、临床特点、治疗方式、并发症及预后差异。结果2728例病人中,男性1520例(55.72%),单瓣膜疾病中男性病人主动脉瓣病变多见,女性病人二尖瓣病变多见。男性病人平均年龄低于女性(P<0.001);男性病人多合并吸烟、冠心病、心肌病、慢性阻塞性肺疾病、既往冠状动脉旁路移植术史;女性病人多合并高血压、心房颤动/扑动。男性病人左室射血分数低于女性(P<0.001);男性病人因瓣膜病反复住院率(P=0.027)、有创干预治疗率(P=0.026)及住院总费用(P=0.016)高于女性病人。不同性别围术期严重并发症、院内结局及短中期随访主要事件和结局比较,差异无统计学意义(P>0.05)。结论老年退行性心脏瓣膜病男性病人主动脉瓣病变较多,女性病人二尖瓣病变较多,男性病人平均年龄及左室射血分数低于女性病人,多次住院率、有创干预治疗率、住院总费用高于女性病人。

Objective To analysis of gender differences in clinical features and prognosis of senile patients with degenerative valve heart disease.Methods In the China-DVD registration study for Chinese senile patients with valvular heart disease,2728 patients with moderate to severe degenerative valve heart disease who were over 60 years old were enrolled consecutively from 69 hospitals.Based on gender,the patients were divided into 2 groups.The baseline data and data 1-year follow up were collected,disease distribution,clinical features,treatment and prognosis were compared between two groups.Results Among the 2728 patients,1520 were male(55.72%).Aortic valve disease was more common in male patients and mitral valve disease was more common in female patients.The average age of male patients was younger than that of females(P<0.001).Male patients were with more smoking,coronary heart disease,cardiomyopathy,chronic obstructive pulmonary disease,and previous coronary artery bypass graft history;female patients were more likely to have hypertension,atrial fibrillation/flutter.The mean left ventricular ejection fraction was significantly lower in male patients than that in female patients(P<0.001);the recurrent hospitalization rate(P=0.027),invasive intervention rate(P=0.026)and total hospitalization cost(P=0.016)of male patients were higher than those of female patients.There was no significant difference in the major events of perioperative complications,in-hospital outcomes,short and intermediate follow-up between different gender groups.Conclusion There were more aortic valve lesions in male patients and more mitral valve disease in female patients with senile degenerative valve heart disease in China.The mean age and LVEF of male patients were significantly lower than those of female patients.The rate of multiple hospitalizations,invasive interventions,and total cost of hospitalization were higher than that of female patients.