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目的探讨QRS波间期在男性和女性慢性心力衰竭(简称心衰)患者中流行病学分布及其对不同性别心衰患者预后的影响。方法回顾性调查和分析湖北地区8地市12家三级甲等医院2000~2010年心衰住院患者资料。根据年龄将患者分为<30、30~39、40~49、50~59、60~69、70~79和≥80岁组。根据左心室舒张末期内径(LVEDD)将患者分为≤40、41~45、46~50、51~55、56~60、61~65、66~70和>70 mm组。根据QRS波间期将患者分为<80、80~89、90~99、100~109、110~119、120~149和≥150 ms组。分析QRS波间期在男性、女性各组间分布特征。构建Kaplan-Meier曲线分析男性和女性不同QRS波间期组的总死亡率。单因素和多因素Cox比例风险模型评价不同QRS组患者总死亡风险。结果共调查心衰患者16 681例(男性占59.3%)。男性QRS波间期长于女性(P<0.01)。男性和女性QRS波增宽发生率分别24.2%和17.7%(P<0.01)。男性QRS波间期随年龄增长而增加,女性QRS波间期在<70岁时随年龄增长而增加。男性和女性患者QRS波间期均随LVEDD增加而增加。男性患者随访(5.8±1.6)年后各QRS组死亡率分别为31.3%、34.9%、38.3%、42.4%、43.3%、53.5%和59.7%。女性随访5.8±1.6年后各QRS组死亡率分别为19.6%、21.7%、22.5%、25.5%、55.0%、51.2%和59.9%。多因素Cox风险比例模型分析发现,以QRS波间期<80 ms组作对照,男性患者其它各组总死亡风险分别为1.0(P=0.71)、1.3(P=0.05)、1.4(P<0.01)、1.5(P<0.01)、1.6(P<0.01)和2.3(P<0.01);女性患者其它各组总死亡风险分别为0.9(P=0.25)、1.0(P=0.71)、1.1(P=0.78)、1.6(P=0.04)、1.6(P<0.01)和2.5(P<0.01)。结论男性心衰患者QRS波间期和增宽发生率均高于女性。男性QRS波间期随年龄增长而增加,而女性QRS波间期在70岁以下时随年龄增长而增加。男性和女性心衰患者QRS波间期均随左室增大而增加。男性患者总死亡风险在QRS波间期≥90 ms时随间期增加而增加,而女性相应值为≥120 ms。
Objective To investigate the epidemiological distribution of QRS wave interval in patients with chronic heart failure (HF) in male and female patients and its effect on the prognosis of patients with different gender heart failure. Methods We retrospectively investigated and analyzed the data of 12 hospitalized patients with heart failure from 2000 to 2010 in 12 tertiary level hospitals in 8 cities of Hubei Province. According to age, patients were divided into <30, 30-39, 40-49, 50-59, 60-69, 70-79, and> 80 years old. According to the left ventricular end-diastolic diameter (LVEDD), the patients were divided into groups of ≤40,41 ~ 45,46 ~ 50,51 ~ 55,56 ~ 60,61 ~ 65,66 ~ 70 and> 70mm. Patients were divided into <80, 80-89, 90-99, 100-109, 110-119, 120-149, and> 150 ms groups according to the QRS wave interval. Analysis of QRS wave interval distribution characteristics in the male and female groups. Kaplan-Meier curves were constructed to analyze the overall mortality of different QRS wave interval groups in males and females. Univariate and multivariate Cox proportional hazards models were used to evaluate the overall risk of death in patients with different QRS groups. Results A total of 16 681 heart failure patients (59.3% men) were investigated. The QRS wave interval in males was longer than that in females (P <0.01). The incidence of QRS wave broadening in males and females was 24.2% and 17.7%, respectively (P <0.01). Men with QRS wave interval increases with age, female QRS wave interval in <70 years old with age increased. QRS wave interval in both males and females increased with increasing LVEDD. Male patients were followed up for a mean of 31.3%, 34.9%, 38.3%, 42.4%, 43.3%, 53.5% and 59.7% in the QRS group after 5.8 ± 1.6 years. Female follow-up 5.8 ± 1.6 years after the QRS group mortality of 19.6%, 21.7%, 22.5%, 25.5%, 55.0%, 51.2% and 59.9% respectively. Multivariate Cox risk proportional model analysis found that QRS wave interval of <80 ms for the control group, the other male patients with total risk of death were 1.0 (P = 0.71), 1.3 (P = 0.05), 1.4 (P <0.01 ), 1.5 (P <0.01), 1.6 (P <0.01) and 2.3 (P <0.01) .The total risk of death in the other groups was 0.9 (P = 0.25), 1.0 = 0.78), 1.6 (P = 0.04), 1.6 (P <0.01) and 2.5 (P <0.01). Conclusion The incidence of QRS wave interval and broadening in male patients with heart failure are higher than those in women. Male QRS wave interval increases with age, while female QRS wave interval increases with advancing age below 70 years of age. QRS wave interval in both men and women with heart failure increased with increased left ventricular volume. The overall risk of death in men increased with interphase for QRS wave duration ≥90 ms, whereas for women the corresponding value was ≥120 ms.