安徽多中心前瞻性心力衰竭队列基线分析

陈康玉; 严激

doi:10.16766/j.cnki.issn.1674-4152.002265

安徽多中心前瞻性心力衰竭队列基线分析

doi: 10.16766/j.cnki.issn.1674-4152.002265

陈康玉,
严激^,

中国科学技术大学附属第一医院安徽省立医院心内科，安徽合肥 230001

基金项目:

安徽省中央引导地方科技发展专项项目 2016080802D113

详细信息

通讯作者:
严激，E-mail：yanji111111@126.com

中图分类号: R541.6
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- 被引次数: 0
出版历程
- 收稿日期: 2021-04-18
- 网络出版日期: 2022-03-03

Baseline analysis of a multicenter prospective heart-failure cohort in Anhui Province

CHEN Kang-yu,
YAN Ji^,

Department of Cardiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China

摘要

摘要: 目的心力衰竭是常见的心血管疾病之一，其患病率逐年上升，本研究旨在了解安徽地区住院心力衰竭患者的流行病学特点。方法本研究为前瞻性队列研究，入选2016年12月—2018年10月间因心力衰竭住院的患者，安徽地区16家医疗机构通过病例报告表，收集患者住院期间的临床资料，包括人口学特征、合并症、实验室检查、辅助检查、药物应用和住院期间事件发生情况。结果共入组2 794例患者，平均年龄为68岁，以男性(60.5%)和NYHA Ⅲ级(50.3%)的患者为主，高血压病(51.5%)、冠心病(45.5%)和心房扑动或颤动(35.6%)位列合并症的前3位，射血分数保留和降低的心力衰竭患者比例分别为43.1%和39.0%。血管紧张素受体脑啡肽酶抑制剂/血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体拮抗剂、β受体阻滞剂和醛固酮受体拮抗剂的使用率分别为65.6%、64.1%和89.4%。平均住院天数为9 d，射血分数降低心力衰竭组住院天数长于射血分数保留心力衰竭组(P=0.005)。患者院内死亡率为1.8%，不同心衰类型间住院死亡率差异无统计学意义。结论安徽地区住院心力衰竭患者的人群特征与全国类似，规范化药物使用率有提高，但与指南仍存在差距。
- 心力衰竭 /
- 队列研究 /
- 流行病学
Abstract: Objective Heart failure is one of the most common cardiovascular diseases, and its prevalence rate is increasing yearly. This study aimed to understand the epidemiological characteristics of hospitalised patients with heart failure in Anhui province. Methods This study was a prospective cohort one. Patients hospitalised for heart failure from December 2016 to October 2018 were selected. We included 16 hospitals in Anhui Province. The clinical data of patients including demographic characteristics, complications, laboratory examination, auxiliary examination, drug application, and events during hospitalisation were collected through case report forms. Results A total of 2 794 patients were enrolled, with an average age of 68 years old, primarily male (60.5%) and NYHA Ⅲ (50.3%). Hypertension (51.5%), coronary heart disease (45.5%), and atrial flutter or fibrillation (35.6%) were the top three complications. The proportion of HFpEF and HFrEF patients were 43.1% and 39.0%, respectively. The utilisation rates of ARNI/ACEI/ARB, beta blocker, and aldosterone receptor antagonist were 65.6%, 64.1%, and 89.4%, respectively. The average length of hospital stay was 9 days, which was longer in the HFrEF group than in the HFpEF gourp (P=0.005). The in-hospital mortality was 1.8%, and no significant difference existed amongst different types of heart failure. Conclusion The population characteristics of hospitalised patients with heart failure in Anhui are similar to those in China. The standardised drug-use rate has improved, but there is still a gaps in the guidelines remain.
- Chronic heart failure /
- Cohort study /
- Epidemiology

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图 1 安徽地区心力衰竭队列研究流程图

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图 2 不同NYHA心功能分级患者药物应用

与NYHA Ⅱ级组比较，^aP < 0.05。

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图 3 不同左室射血分数患者药物应用

注：与HFpEF组比较，^aP < 0.05；与HFmrEF组比较，^bP < 0.05。

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图 4 不同心衰类型和NYHA分级患者的中位住院天数

下载: 全尺寸图片幻灯片

表 1 不同左心室射血分数患者基线资料情况

项目	总体 (n=2 794)	HFpEF (n=1 203)	HFmrEF (n=501)	HFrEF (n=1 090)	统计量	P值
年龄(x±s，岁)	68±13	71±12	69±12	64±13	92.364^a	＜0.001
男性[例(%)]	1 691(60.5)	624(51.9)	320(63.9)	747(68.5)	69.312^b	＜0.001
女性[例(%)]	1 103(39.5)	579(48.1)	181(36.1)	343(31.5)
收缩压(x±s，mm Hg)	130±22	135±22	131±22	124±21	68.165^a	＜0.001
舒张压(x±s，mm Hg)	78±14	79±14	78±15	78±14	1.352^a	0.259
NYHA心功能分级[例(%)]					4.828^b	0.089
Ⅱ级	508(18.2)	191(15.9)	101(20.2)	216(19.8)
Ⅲ级	1 404(50.3)	619(51.5)	250(49.9)	535(49.1)
Ⅳ级	882(31.6)	393(32.7)	150(29.9)	339(31.1)
病因与合并症[例(%)]
高血压病	1 438(51.5)	718(59.7)	280(55.9)	440(40.4)	90.206^b	＜0.001
冠心病	1 272(45.5)	557(46.3)	285(56.9)	430(39.4)	42.591^b	＜0.001
心房扑动或颤动	996(35.6)	571(47.5)	152(30.3)	273(25.0)	132.789^b	＜0.001
扩张型心肌病	501(17.9)	47(3.9)	53(10.6)	401(36.8)	442.588^b	＜0.001
瓣膜性心脏病	251(9.0)	157(13.1)	39(7.8)	55(5.0)	45.889^b	＜0.001
糖尿病	619(22.2)	241(20.0)	131(26.1)	247(22.7)	7.933^b	0.019
超声心动图检查
LVEF(x±s，%)	46±16	62±7	44±3	30±6	7 588.267^a	＜0.001
血液检查
氨基末端B型钠尿肽前体[M(P₂₅, P₇₅)，pg/mL]	2 427(1 412, 4 670)	1 977(1 270, 3 491)	2 580(1 408, 5 092)	3 303(1 877, 5 767)	132.534^c	＜0.001
血肌酐[M(P₂₅, P₇₅)，μmol/L]	85(69, 108)	82(67, 105)	86(69, 115)	88(71, 110)	16.729^c	＜0.001
血红蛋白浓度(x±s，g/L)	124±21	120±21	124±21	129±19	46.790^a	＜0.001
注：LVEF为左心室射血分数; HFrEF为射血分数降低的心力衰竭；HFmrEF为射血分数中间值的心力衰竭；HFpEF为射血分数保留的心力衰竭；^a为F值，^b为χ²值, ^c为H值。1 mm Hg=0.133 kPa。

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参考文献(16)

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