慢性心力衰竭患者长期随访研究

A Long-Term Follow-Up Study of Patients with Chronic Heart Failure

目的研究慢性心力衰竭(CHF)患者的生存率、死亡原因及与预后相关的影响因素等,为CHF提供一定的流行病学参考。方法入选2009年9月—2010年5月确诊的295例CHF患者。采用电话咨询、预约来院、到户走访等每年随访1次,应用寿命表、Kaplan-Meier法分析生存率,采用Cox比例风险模型分析与预后相关的影响因素,并观察基础用药变化情况。结果(1)患者随访1~117个月,平均81个月,随访期死亡136例,脱落62例,完成随访97例;(2)CHF患者1、5、9年的累积生存率分别为90.4%、65.0%、51.1%,中位生存时间约为114个月;(3)CHF死亡前三位原因是CHF急性加重(86.02%)、心脏猝死(5.14%)、急性心肌梗死(3.67%);(4)无心梗病史、无合并症、纽约心脏病协会(NYHA)分级Ⅱ级的CHF患者远、近期累积生存率均较高,射血分数35%的CHF患者远期生存率较高,差异均有统计学意义(P<0.05);(5)NYHA分级Ⅲ级、有合并症、未规范药物治疗、射血分数<35%、左心室舒张末期内径>55 mm、右心房内径>41 mm、体重指数24 kg/m^(2)、血清白蛋白<40 g/L、血清总胆红素>17.1μmol/L、尿素氮>7.14 mmol/L与CHF患者的死亡风险有关,差异均有统计学意义(P<0.05);(6)与随访前比较,β受体阻滞剂、螺内酯、利尿剂、肾素-血管紧张素系统阻滞剂使用比例增长均超过10%。结论本研究中CHF患者近10年生存率较既往研究有所升高,NYHA分级、合并症数量、规范药物治疗、射血分数、左心室舒张末期内径等是影响CHF患者预后的预测因素。

Objective To study the survival rate,causes of death and prognostic factors in patients with chronic heart failure(CHF),so as to provide some epidemiological reference for CHF.Methods Totally 295 patients with CHF diagnosed from September 2009 to May 2010 were selected.The patients were followed up once a year by telephone consultation,medical appointment,household visits,etc.Life table and KaplanMeier method were used to analyze the survival rate,and Cox proportional hazards model was used to analyze the prognostic factors,and the changes of basic medication were observed.Results(1)The follow-up was 1-117 months,with an average of 81 months.During the follow-up period,136 died,62 dropped out and 97completed the follow-up.(2)The cumulative survival rates of CHF patients at 1,5,and 9 years were 90.4%,65.0%and 51.1%,respectively.The median survival time was about 114 months.(3)The top three causes of CHF death were acute exacerbation of CHF(86.02%),sudden cardiac death(5.14%),and acute myocardial infarction(3.67%).(4)The long-term and short-term cumulative survival rates of CHF patients with no history of myocardial infarction,no comorbidities,and New York heart association(NYHA)classⅡwere higher,and the long-term survival rate of CHF patients with ejection fraction 35%was higher,and the differences were statistically significant(P<0.05).(5)NYHA classⅢ,comorbidities,without standard drug treatment,ejection fraction<35%,left ventricular end-diastolic diameter>55 mm,right atrial diameter>41 mm,body mass index 24 kg/m^(2),serum albumin<40 g/L,serum total bilirubin>17.1μmol/L,blood urea nitrogen>7.14 mmol/L were associated with the mortality risk of CHF patients,and the differences were statistically significant(P<0.05).(6)Compared with that before the follow-up,the proportion ofβ-blockers,spironolactone,diuretics,renin-angiotensin system blocker increased by more than 10%.Conclusions The survival rate of CHF patients in recent 10 years in this study is higher than that in previous studies.NYHA classification,number of comorbidities,standardized drug treatment,ejection fraction and left ventricular enddiastolic diameter are predictive factors affecting the prognosis of CHF patients.