基于真实世界数据的冠状动脉粥样硬化性心脏病患者左心室功能不全的危险因素研究

Risk Factors of Left Ventricular Cardiac Dysfunction Coronary Artery Disease Patients Based On Real World Data.

目的探讨冠心病患者左心室收缩功能不全、舒张功能不全的危险因素。方法回顾性研究纳入2008年至2012年四川大学华西医院行冠状动脉造影确诊为冠心病且行超声心动图检查的985例冠心病患者。根据左室射血分数(LVEF)和二尖瓣早期充盈峰值速度与二尖瓣环早期舒张速度(E/e’)的比值,患者被分为四组:(1)心功能正常组(LVEF和E/e’比值正常);(2)收缩功能不全伴Ⅱ~Ⅲ级舒张功能不全组(LVEF降低,E/e’比值升高);(3)单纯舒张功能不全组(LVEF正常和E/e’比值升高);(4)收缩功能不全伴Ⅰ级舒张功能不全组(LVEF降低,E/e’比值正常)。研究者使用倾向评分匹配分别将组(2)、组(4)与组(1)进行最邻近匹配后,再对年龄、性别、吸烟、心率、既往病史、空腹血糖、血钾、脑钠肽前体等因素进行多因素Logistic分析。结果性别、吸烟、心衰史、高血压病史、心梗史、肌酸激酶同工酶、脑钠肽前体、QT间期等指标在四组间差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示吸烟是我国冠心病患者出现收缩功能不全伴Ⅱ~Ⅲ级舒张功能不全(OR=3.011,P=0.037)以及收缩功能不全伴Ⅰ级舒张功能不全(OR=13.170,P=0.002)的危险因素。多因素Logistic回归分析还发现性别是冠心病患者出现单纯舒张功能不全的危险因素(OR=1.932,P=0.008)。结论吸烟是冠心病患者出现左室收缩功能不全和舒张功能不全的危险因素。与男性冠心病患者相比,女性冠心病患者更容易出现单纯舒张功能不全。应教育冠心病患者彻底戒烟,并加强对女性冠心病患者心功能的监测。

Objective To explore risk factors of left ventricular systolic dysfunction(SD) and diastolic dysfunction(DD) in patinets with coronary artery disease(CAD).Methods From 2008 to 2012, 985 CAD patients who were diagnosed by coronary angiography and underwent echocardiography at West China Hospital of Sichuan Univesity went enrolled in this retrospective study.According to left ventricular ejection fraction(LVEF) and ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity(E/e’), patients were divided into four groups:(1)normal cardiac function(normal LVEF and E/e’ ratio);(2)SD concomitant with grade Ⅱ~Ⅲ DD(reduced LVEF and increased E/e’ ratio);(3)DD(normal LVEF and increased E/e’ ratio);(4)SD concomitant with grade Ⅰ DD(reduced LVEF and normal E/e’ ratio).Researchers used propensity score matching to match group(2), group(4) with group(1) separately to the nearest neighbors, and multivariate Logistic analyses were performed on age, gender, smoking, heart rate, past medical history, fasting blood glucose, serum potassium, and brain natriuretic peptide precursors.Results Gender, smoking, history of heart failure, history of hypertension, history of myocardial infarction, creatine kinase isoenzyme, pro-brain natriuretic peptide, QT interval and other indicators were statistically different among four groups(P<0.05).Multivariate logistic regression analysis showed that smoking was a risk factor for both SD & grade Ⅱ~Ⅲ DD[Odds ratio(OR), 3.011,P=0.037]and SD & grade I DD(OR=13.170,P=0.002).And sex was a risk factor for DD(OR=1.932,P=0.008) in Chinese CAD patients.Conclusion Smoking is a risk factor for left ventricular SD and DD.Compared with males, female Chinese CAD patients are more likely to suffer from DD in Chinese CAD patients.CAD patients should be educated to quit smoking completely.We should strengthen monitoring the cardicac function of female CAD patients.