摘要
目的:调查慢性心力衰竭(心衰)住院患者的流行病学现状,为心衰的防治提供依据。方法:对168例病历慢性心衰住院患者临床资料进行横断面调查研究。结果:(1) 168例患者中男性58.9%,女性41.1%,性别之间有统计学差异(P<0.05)。心功能I ~IV级分别所占比例依次为:13.%,30.9%,36.3%,19.1%,心功能III级患者最多。汉族55.9%,少数民族44.1%。平均年龄58.34±15.72岁,在60-69岁年龄段发病人数最多。平均住院天数11.08±7.51天,随着心功能分级程度增加,住院天数延长。(2)主要病因:冠状动脉粥样硬化性心脏病34.5%;高血压性心脏病13.1%;心肌病13.1%;风湿性心脏瓣膜病12.5%;肺源性心脏病11.3%。(3)感染是最重要的诱发因素占68.5%。(4)心衰功能学指标平均左心室射血分数42.01±15.35(%),平均左心室舒张末期内径61.42±13.67(mm)。(5)住院期间用药血管紧张素转换酶抑制剂(ACEI)和利尿剂的使用在80%以上,硝酸酯类和洋地黄的使用在60%以上。(6)住院期间总死亡率为10.1%。结论:慢性心衰住院患者男性多于女性;心功能I ~IV级分别所占比例中心功能III级患者最多;主要原发病因为冠心病,高血压,心肌病;住院诱因主要是感染;心衰的用药以ACEI和利尿剂等治疗为主;住院期间总死亡率为10.1%,死因为泵功能衰竭及猝死等。
Objectives: To evaluate the epidemiological status with chronic heart failure (CHF) of hospitalized patients, in order to provide a basis for prevention and treatment for heart failure. Methods:To carry out cross-sectional study with 168 clinical data of patients cases. Results:(1)There are 58.9% male and 41.1% female patients in 168 cases ,and significant difference between gender (P <0.05). The proportion of Cardiac function in I ~ IV class as follows: 13.%, 30.9%, 36.3%, 19.1%. there are 55.9% of Chinese and 44.1% of minorities. The average age of 58.34±15.72 years old, the largest number of incidence during the 60-69 age group. The average stay days in hospital with 11.08±7.51 days, and with the increase of cardiac function, stay day in hospital extended.(2) Cause of CHF: There are 34.5% of coronary atherosclerotic heart disease, 13.1% in hypertensive heart disease and same with cardiomyopathy ,12.5% of rheumatic valvular heart disease and 11.3% of pulmonary heart disease.(3)Infection is the most important predisposing factor and its accounted for 68.5%.(4) The average LVEF are 42.01±15.35 (%) and LVEDV 61.42±13.67 (mm).(5) ACEI and Diuretic used at more than 80%, Nitrates and digitalis used at more than 60%.(6) the general death rate is 10.1%.Conclusions:The male sex more than female during CFH hospitalized patients, the patient of third level heart function is the most; Main casea of CHF are coronary heart disease,hypertension,cardiac muscle and so on; infection is mainly case of CHF patients in hospital; The use medicine declining cures the heart with ACEI and Diuretic given the most; The general death rate is 10.1% during in hospital.
引文
[1]吴兆苏,姚崇华,赵冬等,我国多省市心血管病趋势及法定因素的人群监测中华心血管病杂志.1997;25:6-11.
[2]林松柏,宋桂香,周峰,张胜年.上海市‘隆性非传染性疾病流行病学趋势研究: 1951~1998年死亡资料分析.中华流行病学杂志.2001;22:265-8 .
[3]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.慢性收缩性心力衰竭治疗建议.装话心血管病杂志,2002;30:7-23.
[4] LevensonJW,SkerrettPJ,Gaziano-M.Redueing the global burden of cardiovaseular disease:the roleo frisk factors.Prev Cardiol 2002;5:188-99.
[5] HuntSA,BakerDW,ChinMH,etal.ACC/AHA guidelines for the Evaluation and management of chronic heart failure in the adult[J]. Cireulation,2001,104:2996- 3007.
[6] ACC/AHA Guidelines of the evaluation and treatmant of chronic heart failure [J]. Cireulation,2001,104:2996-3007.
[7] Guidelines of the diagnosis and treament of chronic heart failure :task force for the diagnosis and treament of chronic heart failure[J].Eur Heart J,2001,22:1527-1560.
[8] American Heart Assoeiation.Heart disease and srtoke statisties 2004 update[M].Dallas(TX): American Heart Assoeiation,2004:task force for the diagnosis and treament of chronic heart failure.
[9]顾东风,黄广勇,何江,等.中国心力衰竭流行病学调查及其患病率[J].中华心血管病杂志,2003,31:3-6.
[10]田晓青.我国心力衰竭患者达400万[J].中国医学沦坛报,2002,28:1.
[11] Mancini DM, Katz SD, Lang CC, et al. Effect of erythropoietin on exercise capacity in patients with moderate to severe chronic heart failure [J]. Circulation. 2003 107(2):294-299 .
[12] American Heart Association. 2002 Heart and Stroke Statistical Updata. Dallas , TX: American Heart Association , 2002 : 19.
[13]上海市心力衰竭调查协作组.上海市1980、1990、2000年心力衰竭住院患者流行病学及治疗状况调查.中华心血管病杂志,2002 ,30 : 24-27.
[14]金雪娟,王健生,陈灏珠.上海综合性医院住院心脏病病种变化趋势.中国临床医学,2001 ,8 (4) :329– 331.
[15] Towbin J A , Bowles N E. The failing heart . Nature ,2002 ,415 :227– 233.
[16] Kannel WB , Ho K, Thom T. Changing epidemiological features of cardiac failure. Br Heart J , 1994 , 72 (Suppl) : S3-S9.
[17] Young JB. The global ep idemiology of heart failure [ J ]. Med Clin North Am, 2004,88 (5) : 1135– 1143.
[18] Murphy NF, Simp son CR, McAlister FA, et al. National survey of the p revalence, incidence, p rimary care burden, and treatment of heart failure in scotland[ J ]. Heart, 2004, 90 (10) : 1129– 1136.
[19] Torzewski J,Torzewski M,Bowyer DE.et al.C-reactive protein frequentily colocalizes with the terminal complement complex in the intima of early atherosclerotic lesions of human coronary arteries. Arterioscler Throml Vasc Biol,1998;18:1386-1392.
[20] Ridker PM,Cushman M,stampfer JM,et al.Plasma concentration of c-reactive protein and risk of developing peripheral vascular disease. Circulation, 1998 ;98:731-733.
[21] WeiskoPf RB,VieleMK,FeinerJ,et al Human cardiovaseular andMetabolic response to aeute,sever isovolumie anemia[J].JAMA,1998,279:217-221.
[22] Levy PS,Kim SJ,Eekel PK,et al.Limit to cardiac compensation during acute isovolumic hemodilution:influenee of coronary stenosis [J].Am Jphysiol,1993,265: H340-9.
[23] Mancini DM,Katz,Lang CC,et al.Effect of erythropoietin on exercise capacity in patients with moderate to severe chronic heart failure.Ciculation,2003; 107:294~299.
[24] Inder Annad , John J.V McMurray , JamesWhitmore , et al.Anemia And Its Relationship to Clinieal Outeome in Heart Failure[J].Cireulation,2004,110:149-154.
[25] AI-Ahmad A,Rand WM,Maniunath,G,et al. Reduced kidney Function and anemia as risk factors for mortality in Patients with letf ventrieular dysufnetion[J].J Am CollCardiol ,2003,38:955-962.
[26] Sol VD.Effects of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fraction. N Engl J Med ,1992;327:685-690.
[27] Hobbs FD. Putting evidence into p ractice [ J ]. EarHeart J, 1999, 20:11– 13.
[28]戴闺柱.慢性心力衰竭治疗的现代概念[ J ].中华心血管病杂志, 2000, 28 (1) : 75– 78.
[29]李庚山.血管紧张素转换酶抑制剂及血管紧张素受体拮抗剂在心力衰竭治疗中的应用[ J ].内科急危重症杂志, 2000, 6 ( 3) :145– 147.
[30] McMurray JJV.Major beta blocker mortality trials in chronic heart failure: a critical review.Heart,1999;82:IV14-IV22.
[31] Remme WJ, Swedberg K. Guidelines for the diagnosis and treatment of chronic heart failure. Task Force for the diagnosis and treatment of chronic heart failure,European Society of Cardiology .Eur Heart J,2001;22:1527-1560.
[32] Hunt SA,Baker DW,Chin MH, et al.ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adults:executive summary.A report of the American College of Cardiology/American Heart Association Task Force on Practice Guideline(Committee to revise the 1995 Guidelines for the Evaluation and Management of Heart Failure).JACC 2001;38:2101-2113.
[33] Wilson JR,Reichek N,Dunkman WB,et al.Effect of diuresis on the performance of the failing left ventricle in man. Am J Med,1981;70:234-9.
[34] Parker JO. The effects of oral ibopamine in patients with mild heart failure:a double blind placebo controlled comparison to furosemide .Int J Cardiol,1993;40:221-227.
[35] Richardson A,Bayliss J,Scriven AJ,et al.Double-blind comparison of captopril alone against frusemide plus amiloride in mild heart failure.Lancet,1987;2:709-711.
[36] The Captopril-Digoxin Multicenter Research Group.Comparative effects of therapy with captopril and digoxin in patients with mile to moderate Heart failure. JAMA ,1988;259:539-544.
[37] Cleland GF,Clark A.Has the survival of heart failure population changed?Lessons from trials.Am J Cardiol,1999;83:112D-119D.
[38] Gheorghiade M, Cody RJ, Francis GS,et al.Current medical therapy for advanced heart failure.Am Heart J,1998;135:231-248.
[39] Krum H,Bigger JT,Packer M.Effect of long term digoxin therapy on an autonomic function in patients with chronic heart failure.J Am Coll Cardiol,1995;25:289-294.
[40] MERIT-HF Study Group. Effect of metoprolo CR/XL in chronic heart failure : Metoprolo CR/XL Randomised Intervention Trail in Congestive Heart Failure (MERIT-HF). Lancet.1999;353:2001-2007.
[41] McDetmott MM, Feinglass J, Lee P, et al. Heart Failure between 1986 and 1994: Temporal trends in drug-prescribing practices, hosspital readmissions and survival at an academic medical center.Am Heart J,1997;134:901-909.
[42] Packer M, Coats AJS, Fowler MC, et al. Effect of Carvedilol on survival in severe chronic heart failure.N Engl J Med,2001;344:1651-1658.
[43] Coletta AP, Cleland JG, Freemantle N,et al.Clinical trials update from the European Society of Cardiology Heart Failure Meeting:SHAPE,BRING-UP2 VAS, COLAⅡ, FOSIDIAL,BETACAR,CASINO and meta-analysis of cardiac resynchronisationtheraphy .Eur J Heart Fail,2004;6:673-680.
[44] Remme WJ, Riegger G, Hildebrandt P, et al. The benefits of early combination treatment of carvedilol and an ACE-inhibitor in mild heart failure and left ventricular systolic dysfunction. The carvedilol and ACE-inhibitor remodeling mild heart failure evaluation trial(CARMEN).Cardiovasc Drugs Ther ,2004 ;18:57-66.
[45] Friedrich M, Fruhwald R, Peter R, et al. Austrian survey of treating heart Failure- AUSTRIA. Eur J Heart Fail,2004;6:1-7.
[46] Murphy NF, Simpson CR, McAlister FA, et al. National survey of the prevalence ,incidence, primary care burden, and treatment of heart failure in Scotland. Heart,2004;90:1129-1136.
[47] Rywik TM, Rywik SL, Korewicki J, et al.A survey of outpatient management of elderly heart failure patients in Poland-treatment patterns.Int J Cardiol,2004;95: 177-184.
[48] Packer M.Pathophysiological mechanisms underlying the adverse effects of calcium channel-blocking drugs in patients with chronic heart failure.Circulation ,1989;80:Ⅳ59-67 .
[49] Benatar D, Hall V, Reddy S, et al. Clinical and neurohormonal effectof nicardipine hydrochloride in patients with severe chronic heart failure receiving angiotensin-converting enzyme inhibitor therapy.Am J Ther ,1998;52:25-32.
[50]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.慢性收缩性心力衰竭治疗建议.中华心血管病杂志,2002;30:7-23.
[51] 44Milton Packer, J. N. Cohn, W. T. Abraham, et al. Consensus recommendation for the management of chronic heart failure.Am J Cardiol,1999;83:1A.
[52] Parker M. Prospective randomized amlodipine survival evaluation (PRAISE-2).J Amer Coll Cardiol,2000;36:322-323.
[53] Thackray S, Witte K, Clark AL, et al. Clinical trials update: OPTIME–CHF , PRAISE-2,ALL-HAT.Eur J Heart Fail,1999;1:209-212 .
[54] Cohn JN , Ziesche S , Smith R , et al. Effect of the calcium antagonist felodipine as supplementary vasodilator therapy in patients with chronic heart failure treated with enalapril :V-HeFT-Ⅲ. Vasodilator-Heart Failure Trial ( V-HeFT) . Circulation , 1997;96: 856.
[55]中华医学会心血管病学分会,中国部分地区1980、1990、2000年慢性心力衰竭住院病例回顾性调查.中华心血管病杂志2002年8月第30卷第8期.
[56]中华医学会心血管病学会.全国世纪之交心力衰竭学术研讨会纪要[J] .中华心血管病杂志,2002 ,30 :2– 6.
[57] Narang R , Cleland J G, Erhardt L , et al . Mode of death in chronic heart failure : A request for more accurate classification[J] . Eur HeartJ ,1996 ,17 :1390– 1403.
[1] Singla DK, SobelBE. Enhancement by growth factors of cardiac myo-cyte different tiation from embryonic stem cells: A promising foundation for cardiac regeneration[J]. Biochem BiophysResCommun, 2005,335(3)∶637– 642.
[2] Balsam LB, WagersAJ, Christensen JL, et al. Haematopoietic stem cells adoptmature haematopoietic fates in ischaemic myocardium[J].Nature,2004, 428(6983)∶668– 673.
[3] Tang YL, Zhao Q, Zhang YC, et al. Autologous mesenchymal stem cell transplantation induce VEGF and neovascularization in ischemic myocardium[J]. Regul Pept, 2004,117 (1)∶3– 10.
[4] Kamihata Kawamoto A , Gwon H C,Iwaguro H ,et al. Therapeutic potential of ex vivo expanded endothelial progenitor cellfor myocardial ischemia[J ]. Circulation , 2004 , 103(5): 634– 637.
[5] Kobayashi Naito H , Taniguchi S,Kawata T. Embryonic stem cell-derived cardiomyocyte transplantation into the infracted myocardium [J]. Heart Surg Forum, 2002,6: 1.
[6] Nagaya N,KangawaK,ItohT, et al.Transplantation of mesenchymal stem cells improve scardiac function in aratmodel of dilatedcardiomy-opathy J.Circulation, 2005,112(8):1128-1135.
[7] Chang MG,Tung L,Sekar RB,et al.Proarrhythmic potential of mesenchymal stem cell transplantation revealed in an in vitrococulture model J.Circulation,2006,113 (15) :1832-1841.
[8] Orlic D Kajstura J Chimenti S et al Mobilized bone marrow cells repair the infarcted heart improving function and survival Proc NatlAcad Sci USA,2001,28;98(18):10344.
[9] SchachingerV, Erbs S, Elsasser A, et al. Improved clinical outcome after intracoromary administration of bone marrowderived progenitor cells in acute myocardial infarction: final 12 year results of the REPAIR-AMI trial. Eur Heart J, 2006, 27(23):2775– 2783.
[10] Schachinger V, Erbs S, Elsasser A, et al. Intracoronary bone marrow-derived progenitor cells in acute myocardial infarction.Nengl J Med 20061;355 (12) :1210- 1221.
[11] LundeK, Solheim S, Aakhus S, et al. Intracoronary injection of mononuclear bone marrow cells in acute myocardial infarction.Nengl J Med 2006;355 (12):1199-1209
[12] Bartunek J,Vanderheyden M,Vanderckhove B,et al.Intracoronary injection of CD133-positive enriched bone marrow progenitor cells promotes cardiac recovery after recent myocardial infarction:feasibility and safety.Circulation2005; 112(9Suppl): 178-183.
[13] Numaguchi Y, Sone T,Okumura K, et al. The impact of the capability of circulating progenitor cell to differentiate on myocardial salvage in patients with primary acute myocardial infarction [J ].Circulation,2006,114(suppl1):114– 119.
[14] Assmus B, Honold J, Schchinger V, et al. Transcoronary trans2lantation ofprogenitor cells aftermyocardial infarction[J]. N Engl J Med,2006,355: 1222– 1232.
[15] Dai W, Hale SL, Martin BJ. Allogeneic mesenchymal stem cell transplantation in postinfarcted rat myocardium: short-and long-term effects.Circulation2005; 112(2): 214 -223.
[16] Nygren JM Jovinge SB reitbach M et al.Bone marrow-derived Hematopoietic cells generate cardiomyocytes at a low frequency through cell fusion,but not transdifferentiation.Nat Med 2004;10(5):494-501.
[17] Murry CE,Soonpaa MH,Reinecke H,et al.Haematopoietic stem cells do not transdifferentiate into cardiacmyocytes in myocar dialinfarcts.Nature 2004;428(6983): 664-668.
[18] Kajstura J Rota M Whang B et al. Bone marrow cells differentiate in cardiac cell lineages after in farction independently of cell fusion. Circ Res 2005 96(1)127-137.
[19] RutanenJ ,Rissanen T T, Markkanen J E,et al.Adenoviral catheter-mediated intramyocardial gene transfe rusing the matter form of vascular endothelial growth factor-D induces transmural angiogenesis in porcine heart J.Circulation,2004,109 8 :1029-1035.
[20] Guo J,Lin G,Bao C,et al.Insulin-like growth factor 1 improves the efficacy of mesenchymal stem cells transplantation in a rat model of myocardial infarction J.J Biomed Sci,2008,15(1):89-97.
[21] Yang J,Zhou W,Zheng W,et al.Effects of myocardial transplantation of marrow mesenchymal stems cells transfected with vascular endothelial growth factor for the improvedment of heart function and angiogenesis after myocardial infarction J. Cardiology, 2006,107(1):17-29.
