慢型克山病患者左室射血分数恢复正常的预测因素研究

Predictors of recovery of normal left ventricular ejection fraction in patients with chronic Keshan disease

目的:探讨慢型克山病(CKD)患者在标准抗心力衰竭治疗后左室射血分数(LVEF)恢复正常的预测因素。方法:2013年6月至2017年10月,在山东省8个克山病病区县(市)选择CKD患者作为研究对象。收集患者初诊时人口统计学资料及可能与LVEF恢复正常相关的临床指标,并对患者进行标准抗心力衰竭治疗。随访至2019年10月或至全因死亡,采用成组设计,根据LVEF是否恢复正常(LVEF≥50%为恢复正常)将患者分为恢复组和未恢复组,采用多因素logistic回归分析LVEF恢复正常的预测因素。结果:共有98例CKD患者纳入本研究,年龄为(47.51±12.84)岁;体质指数(BMI)为(23.18±4.92)kg/m 2;LVEF为(39.54±8.26)%;男性占65.31%(64/98);美国纽约心脏病协会(NYHA)心功能Ⅱ级和Ⅲ级分别占46.94%(46/98)、53.06%(52/98)。随访时间中位数为26个月,28例(28.57%)患者LVEF恢复正常,LVEF由基线的(43.27±7.85)%增加至(58.74±6.07)%,二者比较差异有统计学意义(t=8.25,P<0.01);70例(71.43%)患者LVEF未恢复正常,LVEF由基线的(37.84±6.93)%增加至(42.94±7.31)%,二者比较差异有统计学意义(t=4.24,P<0.01)。28例LVEF恢复正常患者的恢复时间中位数为14个月,其中随访至6、12和18个月时恢复的患者分别为4例(14.29%)、6例(21.43%)和15例(53.57%),27例(96.43%)患者在3年内LVEF恢复正常。多因素logistic回归分析结果显示,病程[比值比(OR)=0.81,95%置信区间(CI):0.70~0.95,P<0.05]、心电图QRS波时限(OR=0.88,95%CI:0.79~0.98,P<0.05)、LVEF(OR=1.26,95%CI:1.13~1.42,P<0.01)、左室舒张末期内径(LVEDD,OR=0.79,95%CI:0.66~0.90,P<0.01)是LVEF恢复正常的独立预测因素。结论:部分CKD患者经抗心力衰竭治疗后,LVEF可恢复正常。病程较短、心电图QRS波时限较短、基线LVEF较高及LVEDD较小的患者LVEF恢复正常的可能性较大。

Objective To explore the predictors of recovery of normal left ventricular ejection fraction(LVEF)in patients with chronic Keshan disease(CKD)after standard anti-heart failure treatment.Methods From June 2013 to October 2017,CKD patients were selected as the research subjects in 8 Keshan disease counties(cities)in Shandong Province.Demographic data and clinical indicators related to the recovery of normal LVEF were collected at the initial diagnosis,and the patients were given standard anti-heart failure treatment.Follow-up was carried out until October 2019 or until all-cause death.Patients were divided into recovery group and non-recovery group according to whether LVEF returned to normal(LVEF≥50%was normal)by group design,and multi-factor logistic regression was used to analyze the predictors of recovery of normal LVEF.Results A total of 98 CKD patients were included in this study,their average age was(47.51±12.84)years old;body mass index(BMI)was(23.18±4.92)kg/m2;LVEF was(39.54±8.26)%;male accounted for 65.31%(64/98);the New York Heart Association(NYHA)heart function gradeⅡand gradeⅢaccounted for 46.94%(46/98)and 53.06%(52/98),respectively.The median follow-up time was 26 months,the LVEF of 28 patients(28.57%)returned to normal,and the LVEF increased from(43.27±7.85)%of the baseline to(58.74±6.07)%,the difference was statistically significant(t=8.25,P<0.01);LVEF did not return to normal in 70 patients(71.43%),and the LVEF increased from(37.84±6.93)%of the baseline to(42.94±7.31)%,the difference was statistically significant(t=4.24,P<0.01).The median recovery time of 28 patients with normal LVEF recovery was 14 months,of which 4 patients(14.29%),6 patients(21.43%)and 15 patients(53.57%)recovered at follow-up of 6,12 and 18 months,respectively,and 27 patients(96.43%)recovered within 3 years.The results of multivariate logistic regression analysis showed that disease course[odds ratio(OR)=0.81,95%confidence interval(CI):0.70-0.95,P<0.05],electrocardiogram QRS wave duration(OR=0.88,95%CI:0.79-0.98,P<0.05),LVEF(OR=1.26,95%CI:1.13-1.42,P<0.01),and left ventricular end-diastolic diameter(LVEDD,OR=0.79,95%CI:0.66-0.90,P<0.01)were independent predictors of recovery of normal LVEF.Conclusions LVEF can return to normal after anti-heart failure treatment in some CKD patients.Patients with shorter disease course,shorter electrocardiogram QRS wave duration,higher baseline LVEF and lower LVEDD are more likely to recover from LVEF.