健康生活方式与不同性别慢性心力衰竭患者再住院风险的相关性

Association between healthy lifestyle and risk of rehospitalization in male or female patients with chronic heart failure

目的探讨健康生活方式与不同性别的慢性心力衰竭(CHF)患者再住院风险的相关性。方法该研究为病例对照研究。入选2017年1月1日至2018年12月31日河南省人民医院及其合作医院心内科出院的CHF患者,根据随访6个月内再住院情况,男女两性分别分为再住院组和对照组。通过电子病历系统收集患者的一般临床资料,并采用问卷调查的方式收集患者健康生活方式相关的情况。健康生活方式包括4项,分别为不吸烟、适度运动、体重指数(BMI)正常及合理膳食。采用多因素logistic回归模型分析不同健康生活方式及其组合对不同性别的CHF患者再住院风险的影响。结果研究共纳入患者2697例,其中男性1308例(再住院组621例,对照组687例),女性1389例(再住院组684例,对照组705例)。男性患者中,再住院组年龄、居住地、婚姻状况、文化程度、平均月收入和医疗保险与对照组比较差异均无统计学意义(P均>0.05)。女性患者中,再住院组年龄、居住地、婚姻状况、文化程度、平均月收入和医疗保险与对照组比较差异亦均无统计学意义(P均>0.05)。无论在男性还是女性CHF患者中,具有4个健康生活方式均可降低再住院风险(男性OR=0.34、95%CI 0.11~0.76、P=0.002,女性OR=0.27、95%CI 0.13~0.79、P=0.012)。无论在男性还是女性CHF患者中,具有不吸烟及其他任意2个健康生活方式的组合均可降低再住院风险,具体为不吸烟、适度运动、BMI正常的男性OR=0.32、95%CI 0.11~0.99、P=0.043,女性OR=0.28、95%CI 0.12~0.93、P=0.032;不吸烟、适度运动、合理膳食的男性OR=0.42、95%CI 0.24~0.98、P=0.044,女性OR=0.40、95%CI 0.12~0.94、P=0.031;不吸烟、BMI正常、合理膳食的男性OR=0.31、95%CI 0.21~0.92、P=0.039,女性OR=0.27、95%CI 0.11~0.87、P=0.014。在女性CHF患者中,健康生活方式两两组合中的不吸烟和适度运动可降低再住院风险(OR=0.23,95%CI 0.19~0.97,P=0.038),而在男性患者中未见到类似结果(OR=0.65,95%CI 0.33~1.84,P=0.315)。结论保持健康生活方式可降低CHF患者再住院风险,而不同性别的患者相关的健康生活方式及其组合可能有所区别。

Objective To explore the association between healthy lifestyle and risk of rehospitalization in male or female patients with chronic heart failure(CHF).Methods Discharged patients with CHF of Henan Provincial People′s Hospital Collaboration Hospital were recruited in our study from January 1,2017 to December 31,2018.The basic information of patients were collected through the electronic medical record system,the questionnaires were used to collect the related influencing factors.Healthy lifestyle includes 4 items,namely non-smoking,moderate exercise,healthy body mass index(BMI)and reasonable diet.Multivariate logistic regression was used to analyze the association between healthy lifestyle and the risk of rehospitalization of CHF patients of different genders.Results A total of 2697 patients with CHF were enrolled in this study,including 1308 male patients(621 rehospitalizations,687 controls)and 1389 female patients(684 rehospitalizations,705 controls).Among male patients,there was no significant difference in age,residence,marital status,education level,average monthly income,and medical insurance between the rehospitalization group and the control group(all P>0.05).Among female patients,there was no significant difference in age,residence,marital status,education level,average monthly income,and medical insurance between the rehospitalization group and the control group(all P>0.05).Whether in male or female patients with CHF,we found that patients with 4 healthy lifestyles were associated with reduced risk of rehospitalization:male patients OR=0.34,95%CI 0.11-0.99,P=0.002,female patients OR=0.27,95%CI 0.13-0.79,P=0.012.A combination of non-smoking and any other 2 healthy lifestyles was associated with reduced risk of rehospitalization:male patients with no smoking,moderate exercise,healthy BMI,OR=0.32,95%CI 0.11-0.99,P=0.043;female patients OR=0.28,95%CI 0.12-0.93,P=0.032;male patients with no smoking,moderate exercise,reasonable diet OR=0.42,95%CI 0.24-0.98,P=0.044,female patients OR=0.40,95%CI 0.12-0.94,P=0.031;male patients with no smoking,healthy BMI,reasonable diet OR=0.31,95%CI 0.21-0.92,P=0.039,female patients OR=0.27,95%CI 0.11-0.87,P=0.014.In female patients with CHF,the combination of non-smoking and moderate sports was associated with reduced risk of hospitalization(OR=0.23,95%CI 0.19-0.97,P=0.038),while no similar results were seen in male patients(OR=0.65,95%CI 0.33-1.84,P=0.315).Conclusion Healthy lifestyle is associated with reduced risk of rehospitalization in patients with CHF,and the related healthy lifestyle and its combination may differ between male and female patients.