Heart:Graves病相关心力衰竭的发生率、危险因素、自然病史和预后

2021-10-22 从医路漫漫 MedSci原创

Graves病(GD)既可加重既往心脏疾病,又可引起新发心力衰竭(HF),但缺乏大规模研究。我们的目的是调查GD相关心力衰竭的发生率、危险因素和结局。

目的:Graves病(GD)既可加重既往心脏疾病,又可引起新发心力衰竭(HF),但缺乏大规模研究。我们的目的是调查GD相关心力衰竭的发生率、危险因素和结局。

方法:对2009-2019年收治的GD患者进行回顾性分析。根据左心室射血分数<50%和Framingham标准定义射血分数降低(HFrEF),按HFA-Pef标准定义射血分数保留(HFpEF)。排除了因缺血、瓣膜紊乱或其他结构性心脏病引起的心衰。采用比例风险回归分析危险因素和预后。

结果:1371例GD患者中74例(5.4%)发生心力衰竭(HFrEF 31例(2.3%),HFpEF 43例(3.1%))。房颤(HR10.5(3.0-37.3),p<0.001)和促甲状腺素受体抗体(TRAb)水平(HR1.05(1.01-1.09)/单位,p=0.007)是房颤的独立危险因素。慢性阻塞性肺疾病(HR7.2(3.514.6),p<0.001)、高龄(HR1.5(1.22.0)每10年,p=0.001)、显性甲亢(HR6.4(1.527.1),p=0.01)、高体重指数(HR1.07(1.03-1.10)/单位,p=0.001)、高血压(HR3.1(1.3-7.2),p=0.001)是高血压病的独立危险因素。P=0.008)。高位高位射血(HR10.35.5-19.4p<0.001)和高位高位射血(HR6.7(3.712.2),p<0.001)的心血管住院风险均高于高位高位射血(HR10.35.5-19.4p<0.001)。然而,只有高位射血与全因死亡(HR5.171.3-19.9,p=0.02)和室性心动过速/房颤(HR64.3(15.9-259.7),p<0.001)相关。

图1 GD患者发生心力衰竭的中位持续时间。HFrEF的散点图显示在左侧面板上,HFpEF显示在右侧面板上。诊断后1年内,HFrEF和HFpEF的发病率分别为58.1%和69.8%。GD,Graves病;HFpEF,心衰,射血分数保留;HFrEF,心衰,射血分数降低。

图2 预期与观察到的HF发生率。Graves病中新发HF的发生率明显高于丹麦(左组)和英国(右组)人群中年龄匹配的公布率。心衰,心力衰竭。

表1 与GD相关HF、HFrEF和HFpEF相关的单因素危险因素

图3 GD相关HFrEF和HFpEF的结果。对数尺度森林图显示,GD相关HFrEF与GD无HFrEF(左图)以及GD相关HFpEF与GD无HFpEF(右图)的HR与95% CI比较。对年龄、性别和既往心衰进行适当调整。ACS(急性冠脉综合征);GD,格雷夫斯氏病;HFpEF:射血分数保留的心力衰竭;HFrEF:射血分数降低的心力衰竭;TIA:短暂性缺血发作;VF:心室颤动;室性心动过速。

结论:新发心力衰竭发生在5.4%的GD患者中,并与心血管住院和死亡风险增加有关。危险因素包括房颤、高TRAb、高BMI和显性甲状腺功能亢进症。

原文出处:

Naser JA,  Pislaru S,  Stan MN,  Lin G,Incidence, risk factors, natural history and outcomes of heart failure in patients with Graves' disease.Heart 2021 Sep 06

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    2021-10-23 仁者大医
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    2021-10-23 slcumt

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