本文選題：心力衰竭 + 全因死亡��； 參考：《北京協(xié)和醫(yī)學院》2016年博士論文

【摘要】：研究背景：心力衰竭(簡稱心衰,HF)作為各種心臟病的嚴重和終末階段,具有高發(fā)病率、高反復(fù)住院率及高病死率的特點,是老年慢性疾病患者死亡的重要原因。急診科在心衰患者的診治中具有關(guān)鍵作用。我國心力衰竭患者數(shù)量眾多,但國內(nèi)目前尚無針對急診科內(nèi)心衰人群的大型注冊研究,對國內(nèi)心衰患者遠期預(yù)后和治療情況的研究亦甚少。目的：觀察目前我國急性心衰患者治療的現(xiàn)狀及遠期預(yù)后情況,比較HFpEF患者與HFrEF患者終點事件發(fā)生率的差異,比較新發(fā)AHF患者與慢性HF惡化患者終點事件發(fā)生率的差異,分析β RB、ACEI/ARB和MRA的應(yīng)用情況及對于終點事件發(fā)生率的影響,探討影響北京地區(qū)心衰患者預(yù)后的危險因素。方法：對“北京地區(qū)急性心衰登記研究”中納入的HF患者進行3年隨訪,收集患者3年全因死亡、心血管事件及心衰再住院事件的發(fā)生情況以及治療情況,總結(jié)事件發(fā)生率及治療現(xiàn)狀,按照患者基線資料將其分為HFpEF組和HFrEF組,按照既往心衰住院史分為新發(fā)AHF組和慢性HF惡化組,進行統(tǒng)計分析。結(jié)果：1.研究共納入3335例患者,人群平均年齡為67.4±15.8歲,男性占53.2%,隨訪至患者入選三年(第1080天)時,3年失訪率15.23%。2.整體人群3年全因死亡率為47.22%,3年心血管事件發(fā)生率為61.08%,3年心衰再住院率為51.63%,其中,慢性HF患者的3年全因死亡率、心血管事件發(fā)生率及心衰再住院率高于新發(fā)AHF者(49.52%vs 44.93%,61.94%vs 60.22%,53.18%vs 50.09%,P0.05),而HFrEF患者與HFpEF患者3年全因死亡率與心血管事件發(fā)生率相似(41.98%vs 41.55%,62.50%vs 60.96%,P0.05),HFrEF患者3年心衰再住院率略高于HFpEF患者(55.44%vs 51.30%,P=0.042)。3.北京地區(qū)急性心衰患者3年隨訪應(yīng)用神經(jīng)內(nèi)分泌阻滯劑——β RB、ACEI/ARB和MRA類的比例分別為50.9%,40.8%和45.9%,其中HFrEF患者應(yīng)用率明顯高于HFpEF患者�；颊邞�(yīng)用神經(jīng)內(nèi)分泌阻滯劑可以明顯減低心衰患者3年隨訪全因死亡率、心血管事件發(fā)生率和心衰再住院率,且同時應(yīng)用3種藥物的患者預(yù)后較好(3年全因死亡率29.8%,3年心血管事件率61.1%,3年心衰再住院率38.3%),未應(yīng)用神經(jīng)內(nèi)分泌阻滯劑的患者預(yù)后最差(3年全因死亡率66.9%,3年心血管事件率63.8%,3年心衰再住院率52.3%)。4.多因素回歸分析提示影響3年全因死亡率的危險因素包括高齡、高NYHA分級、低BMI、低SBP和心率增加。結(jié)論：北京地區(qū)急性心衰患者遠期預(yù)后較差,3年全因死亡率為47.22%,3年心血管事件發(fā)生率61.08%,3年心衰再住院率51.63%。雖然射血分數(shù)保留的心衰患者與射血分數(shù)減低的心衰患者臨床特征有較大差異,但兩者3年全因死亡率、心血管事件發(fā)生率類似。與初發(fā)AHF的患者相比,慢性心衰急性失代償患者的3年預(yù)后明顯較差,提示對于心衰發(fā)病早期開始強化治療的重要性。神經(jīng)內(nèi)分泌阻滯藥物(包括β受體阻滯劑、ACEI/ARB和MRA)的應(yīng)用與3年預(yù)后的改善呈現(xiàn)明顯的相關(guān)關(guān)系,且同時應(yīng)用3類神經(jīng)內(nèi)分泌阻滯藥物對于預(yù)后的改善作用更為明顯。然而,北京地區(qū)急性心衰患者長期治療現(xiàn)狀并不令人滿意,對于神經(jīng)內(nèi)分泌阻滯治療藥物的使用率仍然較低。多元回歸分析顯示高齡、高NYHA分級、低BMI、低SBP和高心率為3年全因死亡的危險因素,對于臨床上判斷高危病人有一定的指導(dǎo)意義。
[Abstract]:Background: heart failure (HF), as a serious and terminal stage of heart disease, has high incidence, high rate of hospitalization and high mortality. It is an important cause of death in the elderly patients with chronic diseases. The emergency department has a key role in the diagnosis and treatment of heart failure patients. There is not a large registration study on the emergency Kone heart failure population at present. The study on the long-term prognosis and treatment of patients with heart failure in China is very small. Objective: To observe the current status and long-term prognosis of patients with acute heart failure in China, compare the difference of the incidence of final events between HFpEF patients and HFrEF patients, and compare the new AHF patients. The difference in the incidence of endpoint events in patients with chronic HF deterioration, the application of beta RB, ACEI/ARB and MRA, and the impact on the incidence of endpoint events, and the risk factors affecting the prognosis of patients with heart failure in Beijing. Methods: a 3 year follow-up of the patients included in the "study on the acute heart failure in Beijing" was followed up for 3 years and 3 of the patients were collected. The occurrence and treatment of cardiovascular events and heart failure rehospitalization events were all due to death, cardiovascular events and heart failure rehospitalization, and the incidence and status of treatment were summarized. According to the baseline data, the patients were divided into group HFpEF and group HFrEF. According to the history of previous heart failure hospitalization, the new AHF group and the chronic HF deterioration group were divided into two groups, and the results were statistically analyzed. Results: 1. the study included 3335 In the patients, the average age of the population was 67.4 + 15.8 years, and the male accounted for 53.2%. When the patients were followed up to three years (1080th days), the 3 year loss rate of 15.23%.2. was 47.22%, the incidence of cardiovascular events in 3 years was 61.08%, and the recurrence rate of heart failure in 3 years was 51.63%, of which the mortality of 3 years in the chronic HF patients and the cardiovascular events were issued. The rate of birth and heart failure rehospitalization was higher than that of new AHF (49.52%vs 44.93%, 61.94%vs 60.22%, 53.18%vs 50.09%, P0.05), while the 3 year total cause mortality of HFrEF patients and HFpEF patients was similar to that of cardiovascular events (41.98%vs 41.55%, 62.50%vs 60.96%, P0.05), and HFrEF patients with 3 years of heart failure rehospitalization was slightly higher than those of HFpEF patients (51.30%,) .3. patients with acute heart failure in.3. Beijing area were followed up with neuroendocrine blockers - the proportion of beta RB, ACEI/ARB and MRA, respectively, 50.9%, 40.8% and 45.9%, respectively, of which the application rate of HFrEF patients was significantly higher than that of HFpEF patients. Patients with neuroendocrine blockers could significantly reduce the mortality and cardiovascular events in patients with heart failure for 3 years. Patients with 3 kinds of drugs had a better prognosis (3 years of total cause mortality 29.8%, 3 year cardiovascular events 61.1%, 3 years of heart failure rehospitalization rate 38.3%), and those who did not use neuroendocrine blockers were the worst (3 year total cause mortality 66.9%, 3 years cardiovascular event rate 63.8%, 3 heart failure recurrence rate 52.3%).4. Multivariate regression analysis suggested that the risk factors affecting all 3 year mortality included age, high NYHA grade, low BMI, low SBP, and heart rate increase. Conclusion: the long-term prognosis of patients with acute heart failure in Beijing area is poor, the mortality of 3 years is 47.22%, the incidence of cardiovascular events is 61.08%, and the rate of hospitalization of heart failure in 3 years is 51.63%. although the ejection fraction is retained. There are significant differences in the clinical characteristics of heart failure patients and patients with decreased ejection fraction in heart failure, but the incidence of cardiovascular events is similar in the 3 year total mortality rate. Compared with the first AHF patients, the 3 year prognosis of the patients with chronic heart failure is significantly worse, suggesting the importance of the early beginning of intensive treatment for heart failure. The application of blocking drugs (including beta blockers, ACEI/ARB and MRA) has a significant correlation with the improvement of the 3 year prognosis, and the improvement of the prognosis is more obvious with the use of 3 types of neuroendocrine blockers. However, the status of long-term treatment for acute heart failure in Beijing is not satisfactory, and the neuroendocrine obstruction is not satisfactory. The use of drugs for hysteretic therapy is still low. Multiple regression analysis shows that high age, high NYHA grade, low BMI, low SBP and high heart rate are the risk factors of all 3 years of death, which have certain guiding significance in the clinical judgment of high-risk patients.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R541.6

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