肥厚型心肌病患者的生存分析

目的:获得在我院就诊的肥厚型心肌病(HCM)患者的长期预后情况及可能的影响因素。方法:回顾性分析2000年1月至2008年9月在我院就诊的HCM患者457例,男性251例(54.9%),女性206例(45.1%),年龄2～84岁,平均年龄(47.9±16.0)岁。所有患者均有12导联心电图,超声心动图检测结果。对已知的与预后不佳相关的因素如左心室流出道(LVOT)梗阻、最大左心室室壁厚度、左心室内径、左心室射血分数(LVEF)、心功能NYHA分级、家族史、并存疾病、并发症、临床症状等行COX危险因素分析。结果:共有368例患者完成随访,平均随访(41.9±28.4)个月,其中男性248例(67.4%),女性120例(32.6%),随访率为80.5%。共发生25例死亡(5.5%),14例与HCM相关(猝死7例),5年的累积存活率为91.6%,10年为80.9%。第1年病死率为2.8%,第2年病死率为1.7%,第3年病死率为1.4%,第4年病死率为2.7%,第5年病死率为零。心功能NYHA分级(RR=2.90,P=0.017),射血分数(EF)值(RR=0.96,P=0.009)和心房颤动(房颤)(RR=2.40,P=0.009)为HCM死亡的独立危险因素。结论:HCM患者预后与心功能差及发生房颤相关,年龄、流出道梗阻或有家族史均与预后无关。

Iong-term prognosis and probably impact factors of hypertrophic cardiomyopathy patients

Objective:The purpose of this study was to acquire the present situation about long-term prognosis and probably impact factors of hypertrophic cardiomyopathy(HCM) patients who encountered in terti-ary hospitals in China.Methods:We retrospectively analysed 457 patients〔age(47.9 ± 16.0) years;54.9% men〕encountered in our hospital from Jan.2000 to Sep.2008.All cases were documented by 12-lead ECG and percutaneous UCG.We carried factors,which were know n and connected with bad prognosis,on the COX analysis,such as LVOT obstr-uction,maximal left ventricular wall thickness,left ventricular end-diastolic dia-mensi-on,LVEF,NYHA functional class,family history,coexisting disease,complication,clinlcal symptom etc.Results:Altogether have 368 patients who completed the revisit〔revisit rate 80.5%,follow-up(41.9 ± 28.4) months〕.Death occurred in 25 patients(5.5%),HCM-related death occurred in 14 patients(SCD 7 pa-tients).Accumulative 5-and 10-year survival estimates were 91.6% and 80.9%.The first annual mortality is 2.8%,the second is 1.7%,the third is 1.4%,the forth 2.7%,the fifth is 0%.Independent predictors of all-cause mortality were heart function(RR = 2.90,P = 0.017),EF(RR = 0.96,P = 0.009),and AF(RR = 2.40,P = 0.009).Conclusion:The prognosis of HCM patients is related with poor heart function and AF occurrence.