CAJ | 학술논문

目的：探讨慢性充血性心力衰竭并发肺功能损伤的相关危险因素及生存分析。方法选取2009年1月至2011年12月该院诊断为慢性充血性心力衰竭并行肺功能检查的患者327例，依据第1秒用力呼气量（FVC ）预计值将其分为3组：A组（肺功能正常，FVC预计值大于70％），B组（轻度肺功能损伤，FVC预计值60％～70％），C组（中‐重度肺功能损伤，FVC预计值小于60％），随访至2013年1月，随访内容包括患者的基线资料及预后情况，通过Logistic回归分析慢性充血性心力衰竭并发中‐重度肺功能损伤的相关危险因素，Cox回归分析慢性充血性心力衰竭全因死亡的危险因素，Kaplan‐Meier生存曲线分析比较不同严重程度肺功能损伤的生存率。结果（1）慢性充血性心力衰竭并发肺功能损伤的患者有167例（51．1％），其中，并发中‐重度肺功能损伤的为96例（29．4％）；体质量指数（BMI）、吸烟、增大的心胸比为慢性充血性心力衰竭并发中‐重度肺功能损伤的独立相关危险因素（P＜0．05）；（2）心功能Ⅲ～Ⅳ级、中‐重度肺功能损伤是慢性充血性心力衰竭全因死亡的独立危险因素（P＜0．05）；（3）C组与A组、C组与B组之间生存率比较差异有统计学意义（P＜0．05），A、B组间差异无统计学意义（P＞0．05）。结论并发肺功能损伤在慢性充血性心力衰竭的患者中比较常见，且中‐重度的肺功能损伤严重影响患者的预后。
목적：탐토만성충혈성심력쇠갈병발폐공능손상적상관위험인소급생존분석。방법선취2009년1월지2011년12월해원진단위만성충혈성심력쇠갈병행폐공능검사적환자327례，의거제1초용력호기량（FVC ）예계치장기분위3조：A조（폐공능정상，FVC예계치대우70％），B조（경도폐공능손상，FVC예계치60％～70％），C조（중‐중도폐공능손상，FVC예계치소우60％），수방지2013년1월，수방내용포괄환자적기선자료급예후정황，통과Logistic회귀분석만성충혈성심력쇠갈병발중‐중도폐공능손상적상관위험인소，Cox회귀분석만성충혈성심력쇠갈전인사망적위험인소，Kaplan‐Meier생존곡선분석비교불동엄중정도폐공능손상적생존솔。결과（1）만성충혈성심력쇠갈병발폐공능손상적환자유167례（51．1％），기중，병발중‐중도폐공능손상적위96례（29．4％）；체질량지수（BMI）、흡연、증대적심흉비위만성충혈성심력쇠갈병발중‐중도폐공능손상적독립상관위험인소（P＜0．05）；（2）심공능Ⅲ～Ⅳ급、중‐중도폐공능손상시만성충혈성심력쇠갈전인사망적독립위험인소（P＜0．05）；（3）C조여A조、C조여B조지간생존솔비교차이유통계학의의（P＜0．05），A、B조간차이무통계학의의（P＞0．05）。결론병발폐공능손상재만성충혈성심력쇠갈적환자중비교상견，차중‐중도적폐공능손상엄중영향환자적예후。
Objective To discuss the risk factors and outcome of abnormal lung function in adult congenital heart disease .Meth‐ods 327 patients with adult congenital heart disease undergoinglung function testing between January ,2009 to December ,2011 in our hospital were enrolled .Accorded to the severity of lung dysfunction based on predicted values of forced vital capacity (FVC) ,pa‐tients were divided into 3 groups :group A(normal lung function ,predicted FVC >70% ) ,group B(mildly impaired lung function , predicted FVC 60% -70% ) ,group C(moderately to severely impaired lung function ,predicted FVC <60% ) ,all the patients were followed‐up to January in 2013 ,the baseline characteristics and outcome were recorded ,the associate factors of moderately to se‐verely impaired lung function in adult congenital heart disease were analyzed through Logistic regression analysis ,the risk factors of death in adult congenital heart disease were analyzed through Cox regression analysis ,and Kaplan‐Meier curve compared survival rate of patients in the 3 groups .Results Lung function was abnormal in 167 patients(51 .1% ) with adult congenital heart disease , in which moderately to severely impaired were 96 patients(29 .4% ) .BMI ,smoke and enlarged cardiothoracic ratio were independent associate factors of moderately to severely impaired lung function in adult congenital heart disease (P<0 .05) .NYHA Ⅲ - Ⅳ and moderate to severe impairment of lung function were independent predictors of death in adult congenital heart disease .There were significant difference of the survival rate between group A and group C ,group B and group C(P<0 .05) ,but it was not significantly different between group A and group B(P>0 .05) .Conclusion Lung function impairment is common in patients with adult congen‐ital heart disease ,and moderate to severe impairment of lung function seriously impact the outcome of the patients .