摘要
目的调查并总结深圳市人民医院单中心射血分数保留型心力衰竭(HFpEF)患者的病因、合并症、临床特点和治疗情况。方法前瞻性选取深圳市人民医院心衰中心2018年1月至2020年8月收治的HFpEF患者,按照葛式分型分为五种类型。收集入选患者的临床资料,包括人口学信息、诊断、体征、超声心动图、实验室指标和治疗等,对比不同分型之间的差异。结果本研究最终纳入HFpEF住院患者472例,其中男性218例,女性254例,按葛式分型将其分为五种类型,入组患者合并心脑血管疾病的比例由高到低依次为:高血压(56.36%)、心房颤动(40.89%)、心肌梗死(27.54%)、卒中(23.52%);合并非心脑血管疾病的比例由高到低依次为:糖尿病(43.64%),慢性肾病(32.42%),血脂异常(13.14%),外周血管疾病(13.14%),甲状腺功能异常(11.02%),恶性肿瘤(5.08%),哮喘(2.97%);不良生活嗜好的比例为:吸烟(32.20%)、饮酒(28.60%)。HFpEF-1型收入的急诊患者占多数,其心肌梗死发生率(69.0%)和PCI治疗率(77.80%)较其他分型高,而从病因上看患者高血压、糖尿病、血脂异常和吸烟人数呈现相对高值。HFpEF-3型中吸烟人数较其他分型高,也与其可能引发肺心病相关。HFpEF-4型的心房颤动(74.3%)、二尖瓣反流率高且病情重(重度95.7%),并且既往置入起搏器患者率较高(11.7%)。HFpEF-5型因分类属于心脏外因素导致心衰,流行病学史合并糖尿病、高血压、血脂异常、慢性肾病较其他分型高,出现充血性心力衰竭(89.7%)和外周水肿的患者(72.1%)较其他分型有显著统计学差异,其住院天数延长[10.869(6.809~16.383)],30天内再住院率(4.4%)较高。HFpEF-2型静息心率升高明显,差异有统计学意义。HFpEF-4型血钠值较高,HFpEF-1型总胆固醇较高,差异均具有统计学意义(均P<0.05)。HFpEF-5型的NT-proBNP、肌酐和空腹血糖数值较其余类型差异明显,具有统计学意义。而在心脏结构变化方面,HFpEF-4型的左心房大小[48(41~53)]和二尖瓣血流舒张早期与瓣环运动峰值速度比值(E/E’)[20(13.4~23.625)],较其他分型有明显统计学差异,而左心室舒张末大小在各个分型中无明显统计学差异。二尖瓣反流方面,HFpEF-1型轻度比例较多(41.8%),HFpEF-4型中重度比例较多(95.7%)。心力衰竭患者的治疗情况方面,住院期间,使用率较高的药物分别为β受体阻滞剂(89.41%)、他汀类药物(87.23%)、抗血小板药(79.45%)和襻利尿剂(79.03%)。HFpEF-2型患者中使用非二氢吡啶类钙拮抗剂(维拉帕米和地尔硫卓)和静脉正性肌力支持类型及β受体阻滞剂较其他分型多。HFpEF-3型患者中使用他汀类药物、二氢吡啶类钙拮抗剂、血管紧张素转化酶抑制剂(ACEI)和硝酸酯类占比较多,HFpEF-5型患者用药中髓袢利尿剂、呋塞米、地高辛、抗凝药、非甾体抗炎药、醛固酮受体阻断剂使用率较其他四种类型多。结论从葛式分型中看,HFpEF-1型占比较多,每一型患者的病因、合并症和临床特征都有所不同。葛氏分型的精髓在于明确了心力衰竭患者的病因和诱因,可以尽早启动针对性治疗方案,并且重视早期预防。
Objective To investigate the etiology,comorbidities,clinical features and treatment of heart failure patients with preserved ejection fraction(HFpEF).Method The HFpEF patients admitted to the Heart Failure Center of Shenzhen People’s Hospital from January 2018 to August 2020 were prospectively selected and divided into five types according to Type-Ge classification.Collect clinical the data of the selected patients,including the demographic information,diagnosis,physical signs,echocardiography,laboratory indicators and treatment,etc.and compare the differences between the different types.Result The study included 472 hospitalized patients with heart failure,including 218 males and 254 females.According to the Type-Ge type classification,the HFpEF patients were divided into five types.The common combined cardiovascular and cerebrovascular diseases in hospitalized patients with heart failure were hypertension(56.36%),atrial fibrillation(40.89%),myocardial infarction(27.54%)and stroke(23.52%);while as the proportion of non-cardiocerebrovascular diseases in descending order were diabetes(43.64%),chronic kidney disease(32.42%),dyslipidemia(13.14%),peripheral vascular disease(13.14%),thyroid function abnormality(11.02%),malignant tumors(5.08%)and asthma(2.97%).Among all the cases,the proportions of having bad living habits were smoking(32.20%)and drinking(28.60%).HFpEF-1 patients were mainly admitted through emergency department.The epidemiological history showed an incidence of higher myocardial infarction(69.0%)and PCI treatment rate(77.80%)than that of other types.Etiologically,among patients with hypertension,diabetes and dyslipidemia,the number of smoker was relatively larger and the number of smoker in HFpEF-3 was higher than the other types,which was also related to the possibility of pulmonary heart disease.HFpEF-4 had a high rate of atrial fibrillation(74.3%),mitral regurgitation with severe disease(severe 95.7%)and the rate of patient that had pacemaker was also relatively higher(11.7%).HFpEF-5 patients tended to have more extracardiac factors and had more cases with the epidemiological history of diabetes,hypertension,dyslipidemia,and chronic kidney disease.Thus,the rates of HFpEF-5 patients with congestive heart failure(89.7%)and peripheral edema(72.1%)were higher that showed statistical significance as compared to that of other types;the patients of this type tended to have the prolonged days of hospitalization[10.869(6.809~16.383)]and higher re-hospitalization rate within 30 days(4.4%).The resting heart rate for HFpEF-2 patients was significantly higher with statistical differences.The blood sodium value was higher in HFpEF-4 and total cholesterol in HFpEF-1 was higher,both of which ware statistically different(average P<0.05).As NT-proBNP,serum creatinine,and fasting blood glucose values,among these five types,HFpEF-5 was significantly different with the other types.In terms of changes in heart structure,when comparing the size of the left atrium[48(41~53)]and early diastolic velocity of mitral valve orifice/early diastolic velocity of tissue Doppler in the sidewall of the mitral annulus and ventricular septum(E/E’)[20(13.4~23.625)],HFpEF-4 was statistically different to the other types,while the end-diastolic size of the left ventricle was not statistically different in each type.As for mitral regurgitation,HFpEF-1 patients had a higher proportion of being mild(41.8%)but HFpEF-4 patients had a higher proportion of being moderate to severe(95.7%).About the treatment status of patients with heart failure during hospitalization,the drugs with the higher usage rate wereβ-blockers(89.41%),statins(87.23%),antiplatelet drugs(79.45%),loop diuretics(79.03%).HFpEF-2 patients used non-dihydropyridine calcium antagonists(verapamil and diltiazem),intravenous positive inotropic support types,andβ-blockers more than patients of other types.The use of statins,dihydropyridine calcium antagonists,angiotensin converting enzyme inhibitors(ACEI)and nitrates were more common for patients of HFpEF-3.The use of loop diuretics and furosemide rice,digoxin,anticoagulants,non-steroidal anti-inflammatory drugs and aldosterone receptor blockers ware more frequently for patients of HFpEF-5 than other 4 types.Conclusion In view of the Type-Ge classification,the HFpEF-1 accounts for more and the etiology,comorbidities and clinical characteristics of each type of the patients are different.Type-Ge classification emphasizes the identification of the causes and complications of heart failure.The causes and incentives are clarified the targeted treatment programs can be initiated as soon as possible and the early prevention is emphasized.
作者
刘诚
李江华
李唐志铭
刘启云
刘华东
孙鑫
林峰
刘峰
邓次妮
董少红
LIU Cheng;LI Jiang-hua;LI Tang-zhiming;LIU Qi-yun;LIU Hua-dong;SUN Xin;LIN Feng;LIU Feng;DENG Ci-ni;DONG Shao-hong(Department of Cardiology,Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center,Shenzhen People's Hospital(The Second Clinical Medical College Jinan University,The First Affiliated Hospital,Southern University of Science and Technology),Shenzhen 518020,China)
出处
《中国心血管病研究》
CAS
2021年第6期481-488,共8页
Chinese Journal of Cardiovascular Research
基金
国家自然科学基金(81770496)
广东省医学科研基金(A2018530)。
关键词
射血分数保留型心力衰竭
流行病学
临床特征
Heart failure with preserved ejection fraction
Epidemiology
Clinical features
作者简介
通信作者:董少红,E-mail:dsh266@outlook.com。
