上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

舒张性心力衰竭患者长期预后的性别差异

于彤彤，王传合，刘双双，王菁菁，韩苏，孙兆青，孙志军   

  1. 中国医科大学附属盛京医院心内科， 沈阳 110004
  • 出版日期:2016-02-28 发布日期:2016-03-29
  • 通讯作者: 孙志军, 电子信箱: sunzj_99@163.com。
  • 作者简介:于彤彤(1983—)， 男， 主治医师， 硕士生; 电子信箱: cmuytt@sina.cn。

Gender difference of long term prognosis of patients with diastolic heart failure

YU Tong-tong, WANG Chuan-he, LIU Shuang-shuang, WANG Jing-jing, HAN Su, SUN Zhao-qing, SUN Zhi-jun   

  1. Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, China
  • Online:2016-02-28 Published:2016-03-29

PDF (PC)

975

摘要：

目的 探讨舒张性心力衰竭患者长期预后的性别差异。方法 连续入选562例舒张性心力衰竭患者，其中女性297例（占52.8%），平均随访3.7年。以全因死亡为主要终点，通过Cox回归分析探讨不同性别舒张性心力衰竭患者长期预后的差异。结果 与男性组相比，女性组年龄较大，入院收缩压较高，糖尿病、贫血者较多，吸烟者较少。超声心动图检查中，女性组舒张末期容积、收缩末期容积较低。实验室检查中，女性组血清总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、血钠较高，但红细胞、血红蛋白、前白蛋白、谷丙转氨酶、肌酐、尿酸、尿素氮、血钾、肌钙蛋白Ⅰ及肌酸激酶MB同工酶较低。出院药物应用方面，两组之间差异均无统计学意义。随访期间，整体全因病死率为24.0%，女性组为23.9%，男性组为24.2%。Kaplan-Meier生存分析（Log-Rank，P=0.924）、Cox单因素回归分析（HR=1.016，95%CI为0.725~1.425，P=0.924）及校正了所有临床因素后的多因素回归分析（OR=0.922，95%CI为0.571~1.490，P=0.741）均显示，两组的长期生存率无显著差异。不同性别组Cox多因素分析显示：男性组全因死亡增加的预测因子包括高龄、较高的心功能分级、较高的入院心率、较高的脑钠肽、较低的血钠、较低的血红蛋白、较低的白蛋白、肾功能不全及较高的尿酸；女性组全因死亡增加的预测因子包括高龄、较高的心功能分级、较高的入院心率、较高的脑钠肽、较低的血钠、较低的血红蛋白、较低的白蛋白。结论 舒张性心力衰竭患者的长期预后无显著的性别差异；但不同性别患者独立预后因素不同，需区别对待。

关键词: 舒张性心力衰竭, 预后, 性别差异

Abstract:

Objective To investigate the gender difference of long term prognosis of patients with diastolic heart failure. Methods A total of 562 patients with diastolic heart failure were consecutively enrolled and 297 (52.8%) of them were female. The average follow-up time was 3.7 years. The primary end point was all-cause mortality. Cox regression analysis was adopted to investigate the gender difference of long term prognosis of patients with diastolic heart failure. Results Compared with male patients, female patients were older with higher systolic blood pressure and higher incidences of diabetes and anemia, but less smokers. The echocardiography examination showed that the end-diastolic volume and end-systolic volume of females were lower. The laboratory examination indicated that levels of total cholesterol, lower density lipoprotein, higher density lipoprotein and serum sodium of females were higher, while the red blood cell count and levels of hemoglobin, pre-albumin, alanine aminotransferase, serum creatinine, uric acid, urea nitrogen, serum potassium, cardiac troponin Ⅰ, and creatine kinase MB were lower. The differences of medications between males and females after hospital discharge were not statistically significant. During the follow-up, the all-cause mortality of all patients, female patients, and male patients were 24.0%, 23.9%, and 24.2%, respectively. Kaplan-Meier survival analysis (Log Rank, P=0.924), Cox univariate regression analysis (HR=1.016, 95%CI=0.725-1.425, P=0.924), and multivariate regression analysis (OR=0.922, 95%CI=0.571-1.490, P=0.741) after all clinical factors were corrected indicated that the long term survival rate of males was not significantly different from that of females. Cox univariate regression analysis of different genders showed that predictive factors of the elevated all-cause mortality of males were higher age, higher NYHA status, higher heart rate on admission, higher B-type natriuretic peptide, lower serum sodium, lower hemoglobin, lower albumin, renal insufficiency, and higher uric acid. Predictive factors of the elevated all-cause mortality of females were higher age, higher NYHA status, higher heart rate on admission, higher B-type natriuretic peptide, lower hemoglobin, lower serum sodium, and lower albumin. Conclusion The gender difference of long term prognosis of patients with diastolic heart failure is not significant. But the independent predictive factors of patients with different genders are different, thus males and females should be treated accordingly.

Key words: diastolic heart failure, prognosis, gender difference