缺血性心肌病住院患者的临床特征及其预后因素分析

发布时间：2018-08-12 19:56

【摘要】：目的:本研究通过回顾性分析,调查并了解缺血性心肌病住院患者的临床特征,探讨1年内发生全因死亡的相关因素及独立危险因素,为临床缺血性心肌病的防治提供有益的指导。方法:调查吉林大学白求恩第一医院心内科2014.01.01-2015.12.30住院期间符合ICM诊断标准且资料完整的病历,收集患者一般资料及辅助检查,并随访1年的生存情况,以是否发生全因死亡分为事件组和非事件组,对两组数据进行相关资料的单因素分析,筛选出可能影响ICM事件发生的因素,再将P㩳0.05的相关危险因素纳入多变量Logistic回归分析,进一步探讨影响ICM全因死亡的独立性危险因素。结果:1、通过筛选,符合入选标准患者363例,其中男性224例,女性139例;对上述患者进行1年生存率随访,其中剔除资料不完整患者46例,失访10例(失访率3.15%),最终完成随访并资料完全的患者307例,其中男性189例,女性118例。平均住院天数为8.04±4.36(天),1年内总死亡率为37.67%。2、以NYHA分级III、IV级进行分组比较,发现在NYHA分级IV级患者中合并糖尿病的发病率较高,入院时心率偏快,并且住院时间天数更长,两组差异有统计学意义(P0.05);NYHA分级IV级较III级患者,左房内径和左房内径指数明显增加,贫血程度加重,患者血红蛋白水平、血红蛋白浓度及含量降低,且组间差异具有统计学意义(P0.05)。随着心功能的恶化,慢性炎症反应越严重;心功能IV级组患者白细胞、中性粒细胞百分数及绝对值较心功能III级组明显升高,两组间差异具有统计学意义(P0.05)。3、本研究中进行全因死亡的单因素分析,随着年龄的增加,BMI指数和舒张压降低,心功能恶化以及在合并频发室早+短针室速患者中,全因死亡事件明显增多,组间对比差异具有统计学意义(P0.05)。事件组较非事件组血钠、血钙明显偏低,两组间差异具有统计学意义(P0.05)。事件组较非事件组,红细胞、血红蛋白、红细胞压积、平均血红蛋白浓度及含量明显降低,两组间差异具有统计学意义(P0.05)。对比血清白细胞和中性粒细胞水平,事件组明显高于非事件组,两组间差异具有统计学意义(P0.05)。事件组e GFR明显低于非事件组,两组间差异有统计学意义(P0.05)。事件组白蛋白水平、Pro-BNP、左心房内径及内径指数明显高于非事件组,两组间差异有统计学意义(P0.05)。4、应用多因素分析全因死亡预后的独立危险因素发现,舒张压、频发室早+短阵室速、碱性磷酸酶、白蛋白、淋巴细胞百分数、左室后壁、左心房内径指数是缺血性心肌病患者1年死亡率的独立危险因素(P0.05)。5、以MUSIC风险评分法,进行预测患者的预后。MUSIC风险评分20.5组,1年预后生存率明显降低,并且两组间差异具有统计学意义(P0.05)。结论:1、随着心功能恶化,患者入院时心率增快,住院天数更长,发生贫血、肝、肾功能损害增加;左房体积增大,死亡率增加。2、患者1年内发生全因死亡率可达37.67%,其中舒张压、左室后壁、频发室早+短阵室速、碱性磷酸酶、淋巴细胞百分数、血清白蛋白、左心房内径指数是缺血性心肌病患者1年死亡率的独立危险因素。3、Music评分对于心功能III、IV级的缺血性心肌病患者预后具有一定的预测价值,Music评分20.5分的患者发生全因死亡的风险明显增加。
[Abstract]:Objective: To investigate the clinical characteristics of inpatients with ischemic cardiomyopathy (ICM) by retrospective analysis, to explore the related factors and independent risk factors of all-cause mortality within one year, and to provide useful guidance for the prevention and treatment of ICM. The patients'general data and auxiliary examinations were collected and followed up for one year. The patients were divided into event group and non-event group according to whether all-cause deaths occurred. The data of the two groups were analyzed by single factor analysis. The factors that might affect the occurrence of ICM events were screened out. P? Result: 1. Through screening, 363 patients, including 224 males and 139 females, met the enrollment criteria. The 1-year survival rate of the above patients was followed up, including 46 patients with incomplete data and 10 patients without follow-up (missing). The follow-up rate was 3.15%. Among 307 patients, 189 were male and 118 were female. The average length of stay was 8.04 (+ 4.36) days, and the total mortality rate was 37.67%. 2. Comparing with NYHA grade III and IV, the incidence of diabetes mellitus was higher in NYHA grade IV patients, and the heart rate was faster at admission. The duration of hospitalization was longer, and the difference was statistically significant between the two groups (P 0.05); NYHA grade IV patients, left atrial diameter and left atrial diameter index increased significantly, the degree of anemia worsened, hemoglobin level, hemoglobin concentration and content decreased, and the difference between the two groups was statistically significant (P 0.05). With the deterioration of heart function, chronic inflammation. The percentage and absolute value of leukocytes and neutrophils in patients with cardiac function grade IV were significantly higher than those in patients with cardiac function grade III (P 0.05). There was significant difference between the two groups (P 0.05). The serum sodium and calcium in the event group were significantly lower than those in the non-event group, and the difference between the two groups was statistically significant (P 0.05). The level of white blood cells and neutrophils in the event group was significantly higher than that in the non-event group (P 0.05). The e-GFR in the event group was significantly lower than that in the non-event group (P 0.05). The index of left atrial diameter and diameter was significantly higher than that of non-event group (P 0.05). There was a significant difference between the two groups (P 0.05). Multivariate analysis showed that diastolic pressure, frequent premature and short ventricular tachycardia, alkaline phosphatase, albumin, lymphocyte percentage, left ventricular posterior wall, and left atrial diameter index were independent risk factors for prognosis of all-cause death. The 1-year survival rate of patients with myopathy was significantly lower than that of patients with myopathy (P 0.05). Anemia, increased liver and kidney damage, increased left atrial volume, increased mortality. 2. All-cause mortality within one year was 37.67%. Diastolic blood pressure, left ventricular posterior wall, frequent premature and short ventricular tachycardia, alkaline phosphatase, lymphocyte percentage, serum albumin, and left atrial diameter index were independent risk factors for 1-year mortality in patients with ischemic cardiomyopathy. Risk factors. 3. Music score has a predictive value for the prognosis of patients with grade III and IV ischemic cardiomyopathy. Patients with score 20.5 have a significantly increased risk of all-cause mortality.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.2

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