CAJ | 학술논문

目的探讨慢性心力衰竭(chronic systolic heart failure,CSHF)患者利尿剂种类和用量对心房颤动(房颤)发生风险和预后的影响.方法回顾性分析湖北地区16 681例CSHF住院患者(包括多次入院患者的首次和末次入院)临床资料,所有患者电话随访.以随访结果将患者分为死亡组和存活组；根据多次入院患者首次及末次临床资料将患者分为房颤组和无房颤组、不同利尿剂组、利尿剂不同剂量组.多因素Cox回归分析影响CSHF患者房颤发生风险和总死亡的独立危险因素,ROC曲线评价利尿剂对房颤预测的敏感性和特异性；多因素Cox风险比例模型分析不同利尿剂组、利尿剂不同剂量组房颤发生风险.结果 ①利尿剂(HR 1.549,95％ CI l.246 ～1.854,P＜0.01)是CSHF患者房颤发生的独立危险因素,ROC曲线分析发现,利尿剂增加预测房颤发生的特异性(83.9％对82.3％)；②氢氯噻嗪和呋塞米增加房颤发生风险；氢氯噻嗪＞40 mg/d和呋塞米≥40 mg/d增加房颤发生风险；③不同种类利尿剂均不增加CSHF患者总死亡率.结论利尿剂是CSHF患者房颤发生的独立危险因素.氢氯噻嗪＞40 mg/d和呋塞米≥0 mg/d增加房颤发生风险.
목적 탐토만성심력쇠갈(chronic systolic heart failure,CSHF)환자이뇨제충류화용량대심방전동(방전)발생풍험화예후적영향.방법 회고성분석호북지구16 681례CSHF주원환자(포괄다차입원환자적수차화말차입원)림상자료,소유환자전화수방.이수방결과장환자분위사망조화존활조；근거다차입원환자수차급말차림상자료장환자분위방전조화무방전조、불동이뇨제조、이뇨제불동제량조.다인소Cox회귀분석영향CSHF환자방전발생풍험화총사망적독립위험인소,ROC곡선평개이뇨제대방전예측적민감성화특이성；다인소Cox풍험비례모형분석불동이뇨제조、이뇨제불동제량조방전발생풍험.결과 ①이뇨제(HR 1.549,95％ CI l.246 ～1.854,P＜0.01)시CSHF환자방전발생적독립위험인소,ROC곡선분석발현,이뇨제증가예측방전발생적특이성(83.9％대82.3％)；②경록새진화부새미증가방전발생풍험；경록새진＞40 mg/d화부새미≥40 mg/d증가방전발생풍험；③불동충류이뇨제균불증가CSHF환자총사망솔.결론 이뇨제시CSHF환자방전발생적독립위험인소.경록새진＞40 mg/d화부새미≥0 mg/d증가방전발생풍험.
Objective Less is known about the prognostic value of diuretics for atrial fibrillation(AF) in patients with chronic systolic heart failure(CSHF).Methods Diagnosed with CSHF,16 681 patients from 12 hospitals were analyzed.Patients were categorized into AF group and non-AF group,death group and survival group according to the results of patients' medical records and follow-up.Univariate and multivariate Cox proportional hazards analyses were performed to examine the prognostic value of diuretics in AF and all-cause mortality.The multivariate Cox regression analysis and receiver operating characteristic ( ROC ) curves were performed to examine the sensitivity and specificity of diuretics in predicting AF.Results During 4.37 ±0.78 years follow-up,diuretics exposure ( HR 1.549,95％ CI,1.246 to 1.854,P＜0.01 ) was the independent risk factor for AF.Hydrochlorothiazide＞40 mg/d or furosemide≥40 mg/d can be used as a marker of higher incidence of AF.During(5.82±1.63 )years follow up,diuretics did not increase all-cause mortality.The ROC curve showed diuretics increase the specificity (83.9％ vs.82.3％ )in predicting AF,with AUC 63.2％ (95％ CI,62.1％ to 64.3％ )and 59.1％ (95％ CI,57.9％ to 60.2％ ),respectively.Conclusions Hydrochlorothiazide ＞40 mg/d or furosemide≥40 mg/d is strongly and independently associated with AF in a large group of patients with CSHF.