缺血性心力衰竭与糖尿病共病患者的临床特点及预后分析

李慧颖; 蔡雨伦; 周文丽; 王威; 白永怿; 刘宏斌

doi:10.3969/j.issn.2095-5227.2021.01.009

缺血性心力衰竭与糖尿病共病患者的临床特点及预后分析

Clinical characteristics and prognosis of patients with ischemic heart failure and diabetes mellitus

摘要

摘要:
背景心力衰竭和糖尿病皆是现代重大流行性疾病，缺血性心力衰竭(ischemic heart failure，IHF)是心力衰竭的重要类型，然而国内外关于IHF与糖尿病共病的临床研究甚少。
目的分析IHF与糖尿病共病患者的临床特点及预后。
方法连续收集2016年2月- 2018年1月于解放军总医院第一医学中心心内科入院的IHF患者430例，根据其是否同时患有糖尿病将其分为共病组和IHF组，应用倾向性评分匹配法对两组患者的基线情况进行1∶1匹配，对随访期间的主要不良心脑血管事件(major adverse cardiovascular and cerebrovascular events，MACCE)及生存预后进行分析。
结果 430例IHF患者中176例(40.9%)患有糖尿病。应用倾向性评分匹配后322例患者(共病组和IHF组各161例)纳入分析。共病组纽约心脏病协会心衰程度分级Ⅲ ~ Ⅳ级患者所占比例较IHF组高(85.1% vs 73.9%，χ²=6.322，P=0.012)；6分钟步行试验距离较IHF组更短(287.3±85.6) m vs (315.3±102.3) m，P=0.008。亚组分析，共病组男性的左心室舒张末期内径较IHF组更大(58.1 ± 3.7) mm vs (57.0 ± 2.8) mm，P=0.012。中位随访40个月，共病组全因死亡率高于IHF组(26.7% vs 15.5%，P=0.014)，累积无MACCE生存率明显降低(log-rank χ²=8.623，P=0.003)。
结论合并糖尿病的缺血性心力衰竭患者临床症状更重，糖尿病显著增加缺血性心力衰竭患者全因死亡率及主要不良心脑血管事件风险。

Abstract:
Background Heart failure and diabetes are considered major epidemic diseases in modern times, and ischemic heart failure (IHF) is an important type of heart failure. However, there are few clinical studies on the comorbidity of IHF and diabetes in China.
Objective To analyze the clinical characteristics and prognosis of patients with IHF and diabetes mellitus.
Methods From February 2016 to January 2018, 430 patients with IHF admitted to the First Medical Center of Chinese PLA General Hospital were collected continuously. The patients were divided into comorbid group and IHF group according to whether they had diabetes. The baseline data of the two groups was matched by propensity score matching method. The major adverse cardiovascular and cerebrovascular events (MACCE) during the follow-up period were counted and survival prognosis of the two groups was analyzed.
Results There were 176 (40.9%) cases with diabetes mellitus in the IHF group (n=430), and 322 patients (161 cases in the comorbid group and 161 cases in the IHF group) were analyzed after the application of propensity score matching. The proportion of patients with NYHA class Ⅲ-Ⅳ in the comorbid group was higher (85.1% vs 73.9%, χ²=6.322, P=0.012) than that in the IHF group. The 6-minute walk test distance in the comorbid group was shorter than that in the IHF group (287.3±85.6 m vs 315.3±102.3 m,P=0.008). In subgroup analysis, male patients’ left ventricular end diastolic diameter in the comorbid group was greater than that in the IHF group (58.1±3.7 mm vs 57.0±2.8 mm, P=0.012). The median follow-up time was 40 months. The all-cause mortality in the comorbid group was higher than that in the IHF group (26.7% vs 15.5%, P=0.014). And the cumulative MACCE-free survival rate in the comorbid group was significantly lower than that in the IHF group (log rank χ2=8.623, P=0.003).
Conclusion Ischemic heart failure patients with diabetes mellitus have more severe clinical symptoms. And diabetes mellitus significantly increases all-cause mortality and MACCE risk in patients with ischemic heart failure.

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