中华心律失常学杂志
中華心律失常學雜誌
중화심률실상학잡지
CHINESE JOURNAL OF CARDIAC ARRHYTHMIAS
2012年
5期
365-368
,共4页
代子玄%于胜波%崔红营%秦牧%梁狄%赵庆彦%黄从新
代子玄%于勝波%崔紅營%秦牧%樑狄%趙慶彥%黃從新
대자현%우성파%최홍영%진목%량적%조경언%황종신
慢性收缩性心力衰竭%室性早搏%室性心动过速%影响因素
慢性收縮性心力衰竭%室性早搏%室性心動過速%影響因素
만성수축성심력쇠갈%실성조박%실성심동과속%영향인소
Chronic systolic heart failure%Premature ventricular contraction%Ventricular tachycardia%Influencing factors
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LVEF 0.41 ～ 0.50组相比,LVEF 0.31 ～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.
目的 瞭解慢性收縮性心力衰竭(chronic systolic heart failure,CSHF)住院患者室性心律失常的髮生特點及影響因素.方法 迴顧性調查和分析湖北地區8地市共12傢三級甲等醫院2000年至2010年CSHF住院患者資料,單因素和多因素logistic迴歸分析室性早搏(室早)和室性心動過速(室速)相關危險因素.根據年齡將患者分為≤40歲、41～50歲、51～60歲、61～70歲、71～80歲和≥81歲組；根據心功能分為Ⅰ、Ⅱ、Ⅲ、Ⅳ級(NYHA分級)組；根據左心室射血分數(LVEF)將患者分為LVEF0.41 ～0.50、0.31～0.40、0.21 ～0.30和≤0.20組；根據心力衰竭病因將患者分為冠心病、風濕性心髒病(風心病)、高血壓性心髒病(高心病)和擴張型心髒病(擴心病)組.結果 ①CSHF患者室早和室速的髮生率分彆為68.30％和14.52％.②多因素logistic迴歸分析髮現:室早和室速的髮生風險(HR)在各年齡組間差異無統計學意義；不同心功能組間差異無統計學意義；與冠心病組相比,風心病、高心病和擴心病組室早和室速HR分彆為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隨LVEF降低而顯著增加(與LVEF 0.41 ～ 0.50組相比,LVEF 0.31 ～0.40、0.21 ～0.30和≤0.20組室速HR分彆為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各組間室早HR差異無統計學意義.結論 CSHF患者室早和室速的髮生率高；室速HR隨LVEF減低而增加；不同病因引起的CSHF患者併髮室早和室速情況各不相同.
목적 료해만성수축성심력쇠갈(chronic systolic heart failure,CSHF)주원환자실성심률실상적발생특점급영향인소.방법 회고성조사화분석호북지구8지시공12가삼급갑등의원2000년지2010년CSHF주원환자자료,단인소화다인소logistic회귀분석실성조박(실조)화실성심동과속(실속)상관위험인소.근거년령장환자분위≤40세、41～50세、51～60세、61～70세、71～80세화≥81세조；근거심공능분위Ⅰ、Ⅱ、Ⅲ、Ⅳ급(NYHA분급)조；근거좌심실사혈분수(LVEF)장환자분위LVEF0.41 ～0.50、0.31～0.40、0.21 ～0.30화≤0.20조；근거심력쇠갈병인장환자분위관심병、풍습성심장병(풍심병)、고혈압성심장병(고심병)화확장형심장병(확심병)조.결과 ①CSHF환자실조화실속적발생솔분별위68.30％화14.52％.②다인소logistic회귀분석발현:실조화실속적발생풍험(HR)재각년령조간차이무통계학의의；불동심공능조간차이무통계학의의；여관심병조상비,풍심병、고심병화확심병조실조화실속HR분별위0.430(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)화0.530(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)；실속HR수LVEF강저이현저증가(여LVEF 0.41 ～ 0.50조상비,LVEF 0.31 ～0.40、0.21 ～0.30화≤0.20조실속HR분별위1.760(95％CI,1.218 ～2.345,P＜0.01)、2.396(95％ CI,2.019～2.783,P＜0.01)화4.209(95％ CI,3.554 ～4.862,P＜0.01),단LVEF각조간실조HR차이무통계학의의.결론 CSHF환자실조화실속적발생솔고；실속HR수LVEF감저이증가；불동병인인기적CSHF환자병발실조화실속정황각불상동.
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 ①The incidence of PVC and VT in patients with CSHF was 68.30％ and 14.52％,respectively.②There 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 ～ 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.
