摘要
目的了解慢性收缩性心力衰竭（chronic systolic heart failure，CSHF）住院患者室性心律失常的发生特点及影响因素。方法回顾性调查和分析湖北地区8地市共12家三级甲等医院2000年至2010年CSHF住院患者资料，单因素和多因素logistic回归分析室性早搏（室早）和室性心动过速（室速）相关危险因素。根据年龄将患者分为≤40岁、41～50岁、51～60岁、61—70岁、71～80岁和≥81岁组；根据心功能分为I、Ⅱ、Ⅲ、Ⅳ级（NYHA分级）组；根据左心室射血分数（LVEF）将患者分为LVEF0．41～0．50、0．31—0．40、0．21～0．30和≤0．20组；根据心力衰竭病因将患者分为冠心病、风湿性心脏病（风心病）、高血压性心脏病（高心病）和扩张型心脏病（扩心病）组。结果①CSHF患者室早和室速的发生率分别为68．30％和14．52％。②多因素logistic回归分析发现：室早和室速的发生风险（HR）在各年龄组间差异无统计学意义；不同心功能组间差异无统计学意义；与冠心病组相比，风心病、高心病和扩心病组室早和室速HR分别为0．430（95％CI，0．381～0．497，P〈0．01）、0．559（95％CI，0．322—0．743，P〈0．01）、1．297（95％CI，1．132～1．486，P〈0．01）和0．530（95％CI，0．421～0．652，P〈0．01）、0．896（95％CI，0．775—1．211，P=0．358）、12．111（95％CI，9．820—14．937，P〈0．01）；室速HR随LVEF降低而显著增加（与LVEF0．41～0．50组相比，LVEF0．31—0．40、0．21～0．30和≤0．20组室速HR分别为1．760（95％CI，1．218～2．345，P〈0．01）、2．396（95％CI，2．019—2．783，P〈0．01）和4．209（95％CI，3．554～4．862，P〈0．01），但LVEF各组间室早HR差异无统计学意义。结论CSHF患者室早和室速的发生率高；室速HR随LVEF减低而增加；不同病因引起的CSHF患者并发室早和室速情况各不相同。
Objective To investigate the prevalence of ventricular arrhythmias including premature ventricular contraction （ PVC ） and ventricular tachycardia （VT） in patients with chronic systolic heart failure （CSHF） and analyze the correlation between ventricular arrhythmias and other factors. Methods Data of inhospital patients with CSHF were investigated and analyzed between 2000 and 2010 from 12 hospitals in Hubei Province. Univariate and multivariate logistic proportional hazard analysis （HR）were performed to determinate the relationships between ventricular arrhythmias and other factors, respectively. According to age, patients were divided into less than 40 years,from 41 to 50 years,from 51 to 60 years,from 71 to 80 years and more than 81 years groups. According to cardiac function, patients were divided into NYHA I, II, III and IV groups. Similarly, based on left ventricular ejection fraction（LVEF） , four groups form with from 0.41 to 0. 50, from 0. 31 to 0. 40,from 0. 21 to 0. 30 and less than 0. 20. Based on the etiology of heart failure,patients were divided into coronary heart disease, valvular heart disease, hypertension heart disease and dilated cardiomyopathy groups. Results （1）The incidence of PVC and VT in patients with CSHF was 68.30% and 14. 52%, respectively. （2）There was no significant difference among different age groups in HR of PVC and VT in multivariate logistic analysis, and neither was it among different NYHA heart functional classification groups. Compared with patients with coronary heart disease group, the HR of PVC and VT for patients with valvular heart disease, hypertension heart disease or dilated cardiomyopathy were 0. 430 （ 95 % CI, 0. 381 N 0. 497, P 〈 0. 01 ）, 0. 559 （95% CI,0. 322 -0. 743, P〈0.01 ）, 1. 297 （95% CI, 1. 132 - 1.486, P〈0. 01 ） and 0. 530 （95% CI, 0. 421 0. 652,P〈0. 01 ）, 0. 896 （95 % CI,0. 775 - 1.211, P = 0. 358 ）, 12. 111 （ 95% CI, 9. 820 - 14. 937, P〈0.01 ）, respectively. There were no significant difference among different LVEF groups in HR of PVC in multivariate logistic analysis. However, compared with patients with LVEF 0. 41 - 0. 50 group, the HR of VT for patients in LVEF 0. 31 -0. 40,0. 21 -0. 30 and ≤0. 20 group were 1. 760（95% CI,1. 218 -2. 345 ,P〈0. 01 ） ,2. 396（95% CI,2. 019 - 2. 783 ,P〈0. 01 ） and 4. 209 （ 95% CI, 3. 554 - 4. 862, P〈0. 01 ）, respectively. Conclusion The incidence of PVC and VT was high in patients with CSHF. The risk of VT morbidity increases as LVEF decreases. The prevalence of PVC and VT in patients with CSHF varies in patients with different etiology.
出处
《中华心律失常学杂志》
2012年第5期365-368,共4页
Chinese Journal of Cardiac Arrhythmias
关键词
慢性收缩性心力衰竭
室性早搏
室性心动过速
影响因素
Chronic systolic heart failure
Premature ventricular contraction
Ventricular tachycardia
Influencing factors
