切换至 "中华医学电子期刊资源库"

中华危重症医学杂志(电子版) ›› 2021, Vol. 14 ›› Issue (01) : 20 -24. doi: 10.3877/cma.j.issn.1674-6880.2021.01.004

所属专题: 文献

论著

影响扩张型心肌病患者心脏结构和功能发生逆转的相关因素分析
徐慧1, 李志刚1, 赵燕1, 李小莉1, 韩冰1,()   
  1. 1. 221009 江苏徐州,徐州市中心医院心内科
  • 收稿日期:2020-05-27 出版日期:2021-02-28
  • 通信作者: 韩冰
  • 基金资助:
    江苏省科委社会发展基金项目(BE2015624)

Factors influencing the reversal of cardiac structure and function in patients with dilated cardiomyopathy

Hui Xu1, Zhigang Li1, Yan Zhao1, Xiaoli Li1, Bing Han1,()   

  1. 1. Department of Cardiology, Xuzhou Central Hospital, Xuzhou 221009, China
  • Received:2020-05-27 Published:2021-02-28
  • Corresponding author: Bing Han
引用本文:

徐慧, 李志刚, 赵燕, 李小莉, 韩冰. 影响扩张型心肌病患者心脏结构和功能发生逆转的相关因素分析[J/OL]. 中华危重症医学杂志(电子版), 2021, 14(01): 20-24.

Hui Xu, Zhigang Li, Yan Zhao, Xiaoli Li, Bing Han. Factors influencing the reversal of cardiac structure and function in patients with dilated cardiomyopathy[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2021, 14(01): 20-24.

目的

探讨扩张型心肌病患者药物治疗后发生心脏结构和功能逆转的预测因素。

方法

回顾性分析2016年8月至2017年4月在徐州市中心医院住院的156例扩张型心肌病患者资料,根据患者治疗后的临床效果和超声心动图结果的不同反应性,将156例扩张型心肌病患者分为左心室逆重构(LVRR)组(27例)和非LVRR组(129例)。记录所有患者的年龄、性别、体质量指数、病程、收缩压、纽约心脏病学会分级、高血压、糖尿病、心房颤动、血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体阻滞剂、β受体阻滞剂、螺内酯、完全性左束支传导阻滞、QRS波时限、N末端脑钠肽前体、左心室射血分数、左心室舒张末期内径、左室收缩末期容积指数、6 min步行试验、服药依从性、6个月再住院率及6个月病死率等资料。采用多因素Logistic回归分析扩张型心肌病患者发生LVRR的相关因素;采用受试者工作特征(ROC)曲线分析QRS波时限、服药依从性对扩张型心肌病患者发生LVRR的预测价值。

结果

LVRR组患者年龄[(54 ± 16)岁vs.(60 ± 12)岁,t=5.899,P=0.021]和QRS波时限[(104 ± 21)ms vs.(122 ± 29)ms,t=10.464,P=0.003]均较非LVRR组显著降低,服药依从性[(6.0 ± 1.0)分vs.(5.3 ± 1.5)分,t=8.962,P=0.002]较非LVRR组显著升高。多因素Logistic回归分析结果显示,QRS波时限[比值比(OR)=0.969,95%置信区间(CI)(0.946,0.993),P=0.011]、服药依从性[OR=1.541,95%CI(1.064,2.230),P=0.022]是心功能恢复正常的独立影响因素。ROC曲线分析结果显示,QRS波时限[曲线下面积(AUC)=0.721,95%CI(0.619,0.824),P < 0.001]、服药依从性[AUC=0.661,95%CI(0.559,0.762),P=0.009]均对扩张型心肌病患者发生LVRR具有预测价值。

结论

QRS波时限及服药依从性是扩张型心肌病患者发生LVRR的重要预测因素。

Objective

To explore the predictors for cardiac structural and functional reversal after pharmacological treatment in patients with dilated cardiomyopathy.

Methods

A total of 156 patients with dilated cardiomyopathy admitted to Xuzhou Central Hospital from August 2016 to April 2017 were retrospectively analyzed. According to their clinical outcomes and different reactivity of echocardiographic findings after treatment, 156 patients were divided into a left ventricular reverse remodeling (LVRR) group (n=27) and a non-LVRR group (n=129). The age, sex, body mass index, course of disease, systolic blood pressure, New York Heart Association grade, hypertension, diabetes, atrial fibrillation, angiotensin converting enzyme inhibitor/angiotensin receptor blocker, β receptor blocker, spironolactone, complete left bundle branch block, QRS wave time limit, N-terminal pro-brain natriuretic peptide, left ventricular ejection fraction, left ventricular end-diastolic dimension, left ventricular end-systolic volume index, 6-min walk test, medication compliance, 6-month rehospitalization rate and 6-month mortality rate were recorded for all patients. Multivariate Logistic regression was used to analyze factors related to LVRR in patients with dilated cardiomyopathy. Receiver operating characteristic (ROC) curves were used to evaluate predictive value of QRS wave time limit and medication compliance in LVRR.

Results

Compared with the non-LVRR group, the age [(54±16) years vs. (60 ± 12) years, t=5.899, P=0.021] and QRS wave time limit [(104 ± 21) ms vs. (122 ± 29) ms, t=10.464, P=0.003] were significantly lower and the medication compliance [(6.0 ± 1.0) vs. (5.3 ± 1.5), t=8.962, P=0.002] was significantly higher in the LVRR group. The multivariate Logistic regression showed that the QRS wave time limit [odds ratio (OR)=0.969, 95% confidence interval (CI) (0.946, 0.993), P=0.011] and medication compliance [OR=1.541, 95%CI (1.064, 2.230), P=0.022] were independent factors affecting the return to normal cardiac function. The ROC curve showed that the QRS wave time limit [area under the curve (AUC)=0.721, 95%CI (0.619, 0.824), P < 0.001] and medication compliance [AUC=0.661, 95%CI (0.559, 0.762), P < 0.009] both have predictive value for LVRR in patients with dilated cardiomyopathy.

Conclusion

QRS wave time limit and medication compliance are important predictors for LVRR in patients with dilated cardiomyopathy.

表1 两组扩张型心肌病患者一般资料比较(±s
表2 多因素Logistic回归分析扩张型心肌病患者药物治疗后发生LVRR的影响因素
图1 QRS波时限、服药依从性ROC曲线图
1
Ansara AJ, Kolanczyk DM, Koehler JM, et al. Nepril-ysin inhibition with sacubitril/valsartan in the treatment of heart failure: mortality bang for your buck[J]. J Clin Pharm Ther, 2016, 41 (2): 119-127.
2
Merlo M, Anzini M, Bussani R, et al. Characterization and long-term prognosis of postmyocarditic dilated cardiomyopathy compared with idiopathic dilated cardiomyopathy[J]. Am J Cardiol, 2016, 118 (6): 895-900.
3
Merlo M, Mase M, Vitrella G, et al. Usefulness of addition of magnetic resonance imaging to echocardiographic imaging to predict left ventricular reverse remodeling in patients with nonischemic cardiomyopathy[J]. Am J Cardiol, 2018, 22 (3): 490-497.
4
Rohit MK, Krishnappa D. Incidence and predictors of super-response to cardiac resynchronization therapy[J]. Indian Heart J, 2019, 71 (4): 334-337.
5
Shah RV, Rong J, Larson MG, et al. Associations of circulating extracellular RNAs with myocardial remodeling and heart failure[J]. JAMA Cardiol, 2018, 3 (9): 871-876.
6
Imamura T, Kinugawa K, Nitta D, et al. Erratum: shorter heart failure duration is a predictor of left ventricular reverse remodeling during adaptive servo-venti-Iator treatment in patients with advanced heart failure[J]. Int Heart J, 2018, 59 (2): 456.
7
中华医学会心血管病学分会,中国心肌炎心肌病协作组. 中国扩张型心肌病诊断和治疗指南[J]. 临床心血管病杂志,2018,34(5):421-434.
8
王敏,刘秀静,王敏敏,等. 慢性心力衰竭患者服药依从性与出院指导质量的相关性分析[J]. 齐鲁护理杂志,2019,25(1):27-32.
9
刘园园,崔存英,李亚南,等. 左心室质量指数评价主动脉瓣置换患者术后左心室重构及逆转[J]. 中华超声影像学杂志,2018,27(2):108-113.
10
Tawfik Ghanem M, Allam LE, Samir Ahmed R. Cardiac resynchronization therapy in patients with heart failure and moderately reduced ejection fraction: could it trigger a superresponse?[J]. Indian Heart J, 2019,71 (3): 229-234.
11
牛保松,慕春言,赵玉兰,等. 特发性扩张型心肌病患者左心室逆重构的发生率、预测因素和预后分析[J]. 中国心血管杂志,2020,25(1):40-44.
12
石文惠,张昕. 心电图碎裂QRS波联合心电向量图T环改变对冠心病的诊断价值[J]. 实用心电学杂志,2019,28(1):35-37,41.
13
Tanriverdi Z, Colluoglu T, Unal B, et al. The prognostic value of the combined use of QRS distortion and fragmented QRS in patients with acute STEMI undergoing primary percutaneous coronary intervention[J]. J Electrocardiol, 2018, 51 (2): 210-217.
14
陈思敏,周苏晋,翟南江. 慢性心力衰竭患者心电图QRS波群振幅特点及其临床意义[J]. 现代诊断与治疗,2018,29(21):3470-3472.
15
Zimetbaum PJ, Buxton AE, Batsford W, et al. Electrocardiog raphic predictors of arrhythmic death and total mortality in the multicenter unsustained tachycardia trial[J]. Circulation, 2004, 110 (7): 766-769.
16
Redfors B, Kosmidou I, Crowley A, et al. Prognostic significance of QRS fragmentation and correlation with infarct size in patients with anterior ST-segment elevation myocardial infarction treated with percutaneous coronary intervention: insights from the INFUSE-AMI trial[J]. Int J Cardiol, 2018 (253): 20-24.
17
于万德,程培培,高晓飞,等. QRS波增宽的缺血性心肌病患者PCI术后QRS波时限及心功能变化的随访研究[J]. 国际心血管病杂志,2019,46(5):305-308.
18
Masoudi FA, Baillie CA, Wang Y, et al. The complexity and cost of drug regimens of older patients hospitalized with heart failure in the United States, 1998-2001[J]. Arch Imem Med, 2015, 165 (18): 2069-2076.
19
Wu JR, Moser DK. Medication adherence mediates the relationship between heart failure symptoms and cardiac event free survival in patients with heart failure[J]. J Cardiovasc Nurs, 2017, 33 (1): 40-46.
20
马文元. 综合护理干预对肥厚型心肌病合并心律失常患者负面情绪、依从性及生存质量的影响[J/CD]. 中华危重症医学杂志(电子版),2018,11(1):67-69.
[1] 夏靖涵, 林凤娇, 王胰, 丁戈琦, 张清凤, 张红梅, 谢盛华, 李明星, 尹立雪, 李文华. 二尖瓣空间变化联合左心房应变对肥厚型心肌病合并左心室流出道梗阻的预测价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 585-592.
[2] 王岚, 徐斌胜, 谢乐. 肥厚型心肌病的经胸超声心动图诊断与心电图表现特征[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 593-596.
[3] 陈丹丹, 马小静, 夏娟, 余正春, 谢姝瑞, 程冠, 吴梅. 二维斑点追踪成像技术对肥厚型心肌病患者右心室功能的评价[J/OL]. 中华医学超声杂志(电子版), 2023, 20(04): 417-423.
[4] 张霞, 张瑞, 郑志波, 张勤. 紫草素调控乳酸化修饰和线粒体功能改善脓毒症心肌病小鼠的预后[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(04): 275-284.
[5] 柯晴潆, 沈延飞, 许强宏, 蔡国龙. 预测脓毒性心肌病患者院内死亡风险列线图模型的构建及验证[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(01): 10-18.
[6] 陈宇, 冯芳, 张露, 刘健. 基于生物信息学分析筛选脓毒症心肌病关键致病基因[J/OL]. 中华危重症医学杂志(电子版), 2023, 16(04): 286-291.
[7] 王晓亚, 王燕芸, 顾永忠. 产科快速反应团队成功救治心脏骤停孕产妇1例并文献复习[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(02): 148-156.
[8] 李云智, 蒋晓峰, 金铭, 杨江华, 李海斌, 赵盟杰, 刘冬, 高国静, 孟繁超, 崔功静, 廖晓星. 输尿管软镜碎石术治疗累计直径>2 cm上尿路结石一期清石率影响因素及预测模型建立[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(01): 58-63.
[9] 范家铭, 杨秭莹, 冯振辉, 陈一欢, 王雨桐, 沈振亚. 影响扩张型心肌病干细胞移植疗效的差异miRNA表达分析[J/OL]. 中华细胞与干细胞杂志(电子版), 2023, 13(05): 288-298.
[10] 谢冰冰, 谢曼婷, 向秋玲. 诱导多能干细胞在遗传性心肌病细胞模型中的研究进展[J/OL]. 中华细胞与干细胞杂志(电子版), 2023, 13(05): 315-320.
[11] 贾玲玲, 滕飞, 常键, 黄福, 刘剑萍. 心肺康复在各种疾病中应用的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 859-862.
[12] 刘笑笑, 张小杉, 刘群, 马岚, 赵海玥, 王雅晳. 超声心动图在围生期心肌病中的应用价值研究进展[J/OL]. 中华临床医师杂志(电子版), 2023, 17(11): 1196-1201.
[13] 魏冰倩, 蓝荣芳. 起搏诱导心肌病应对新策略:导线移除与希氏-浦肯野系统起搏升级[J/OL]. 中华心脏与心律电子杂志, 2024, 12(03): 155-160.
[14] 胡梦瑶, 宋怡沛, 龚良庚. 心肌应变成像在糖尿病心肌病评估中的研究进展[J/OL]. 中华心脏与心律电子杂志, 2024, 12(01): 32-35.
[15] 徐欣怡, 顾怡菁, 郭颖, 王秀利, 黄美容, 傅立军, 高伟, 刘廷亮, 李奋. 儿童心动过速性心肌病的临床管理及预后分析[J/OL]. 中华心脏与心律电子杂志, 2023, 11(04): 216-221.
阅读次数
全文


摘要