吸烟状态对男性心力衰竭患者远期心血管不良事件的影响研究

目的 探讨吸烟状态对男性心力衰竭患者远期心血管不良事件的影响。方法 连续入组2013年1月-2018年6月期间诊断的男性心力衰竭患者98例。记录患者的年龄、体重指数、病程、心功能分级、血压、心率、左心室射血分数（LVEF）、基础疾病史、用药情况等。根据吸烟状态，患者分为从不吸烟、已经戒烟、目前吸烟。随访1年，时间截至2019年6月30日，记录患者的临床结局，主要心血管不良事件包括需要住院治疗的心力衰竭，死亡和心源性死亡。使用多变量COX回归分析不同吸烟状态对远期心血管不良事件的影响。结果 本研究中从不吸烟40例（40.82%）、已经戒烟39例（39.80%）、目前吸烟19例（19.39%）。不同吸烟状态患者收缩压、舒张压、心率、高血压病、2型糖尿病、β受体阻滞剂比较差异均有统计学意义（P<0.05）。随访1年，不同吸烟状态患者需要住院治疗的心力衰竭、全因死亡和心源性死亡发生率比较，差异均有统计学意义（P<0.05）。多因素COX回归分析结果显示，排除其他因素干扰后，目前吸烟为需要住院治疗的心力衰竭、全因死亡和心源性死亡的危险因素（P<0.05）。结论 目前吸烟是男性心力衰竭患者长期需要住院治疗、全因死亡和心源性死亡的危险因素，临床医生应对心力衰竭患者进行健康教育，督促其戒烟，以促进其长期预后。

Effects of smoking status on long term cardiovascular adverse events in male patients with heart failure

Objective To explore the effect of smoking status on long term cardiovascular adverse events in male patients with heart failure. Methods A total of ninety eight male patients with heart failure diagnosed between January 2013 and June 2018 were enrolled in the study. The patients' age, body mass index, course of disease, cardiac function grading, blood pressure, heart rate, left ventricular ejection fraction (LVEF), history of underlying diseases and medication were recorded. Patients were divided into those who had never smoked, those who had quit smoking and those who were current smokers according to their smoking status. The patients were followed up for one year until June 30, 2019, and their clinical outcomes were recorded. Major cardiovascular adverse events included heart failure, death and cardiogenic death requiring hospitalization. Multivariate COX regression was used to analyze the effects of smoking status on long term cardiovascular adverse events. Results In this study, 40 patients(40.82%) had never smoked, 39 (39.80%) had quit smoking, and 19 (19.39%) were current smokers.The difference of systolic blood pressure, diastolic blood pressure, heart rate, hypertension, type 2 diabetes mellitus, beta receptor blockers in patients with different smoking status was statistically significant(P<0.05). A one year follow up showed there were statistically significant differences in the incidence of heart failure, all cause death and cardiac death among patients with different smoking status who required hospitalization (P<0.05C). The results of multivariate COX regression analysis showed that after excluding other factors, smoking was currently a risk factor for heart failure, all cause death and cardiogenic death requiring hospitalization(P<0.05). Conclusion At present, smoking is a risk factor for long term hospitalization, all cause death and cardiogenic death in male patients with heart failure. Clinicians should conduct health education for patients with heart failure and urge them to quit smoking to promote their long term prognosis.