Eur Heart J：女性心衰患者转归更佳

　　荷兰一项研究表明，男性和女性心力衰患竭者的临床表现不同，且女性转归更佳。较低的死亡率独立于临床特征的差异，与性别相关的一些生物标志物和死亡率的差异可能部分解释这种生存差异。相关论文2013年5月10日在线发表于《欧洲心脏杂志》（Eur Heart J）。

　　研究对比了567例男女性患者的基线人口统计学、临床特征和多种生物标志物及转归。研究组的患者平均年龄为71 ± 11岁，38%为女性。

　　结果显示，与男性相比，女性年龄、体质指数（BMI）、左室射血分数和高血压患病率更高，且较多接受利尿剂和抗抑郁药治疗，较少接受血管紧张素转换酶抑制剂（ACEI）治疗。3年后，女性的全因死亡比男性更低（37.0 对43.9%，P= 0.016）。女性的炎症相关生物标志物水平（C反应蛋白、正五聚蛋白3、生长分化因子-15和白细胞介素6）和细胞外基质重塑明显更低。N末端脑利钠肽前体、TNF-αR1a和生长分化因子-15在性别和死亡的相关性中发挥最强作用。

与心衰相关的拓展阅读：

• JACC：老年人进行体力活动可降低心衰风险
• JAMA：常用高血压药物能造福更多心衰患者
• 长链单不饱和脂肪酸可增加心衰发生
• 长链单不饱和脂肪酸可增加心衰发生
• Circulation：长链单不饱和脂肪酸可增加心衰发生风险 更多信息请点击：有关心衰更多资讯

Neurohormonal and clinical sex differences in heart failure
Aims
Despite disparities in pathophysiology and disease manifestation between male and female patients with heart failure, studies focusing on sex differences in biomarkers are scarce. The purpose of this study was to assess sex-specific variation in clinical characteristics and biomarker levels to gain more understanding of the potential pathophysiological mechanisms underlying sex differences in heart failure.
Methods and results
Baseline demographic and clinical characteristics, multiple biomarkers, and outcomes were compared between men and women in 567 patients. The mean age of the study group was 71 ± 11 years and 38% were female. Women were older, had a higher body mass index and left ventricular ejection fraction, more hypertension, and received more diuretic and antidepressant therapy, but less ACE-inhibitor therapy compared with men. After 3 years, all-cause mortality was lower in women than men (37.0 vs. 43.9%, multivariable hazard ratio = 0.64; 95% confidence interval 0.45–0.92, P = 0.016). Levels of biomarkers related to inflammation [C-reactive protein, pentraxin 3, growth differentiation factor 15 (GDF-15), and interleukin 6] and extracellular matrix remodelling (syndecan-1 and periostin) were significantly lower in women compared with men. N-terminal pro-brain natriuretic peptide, TNF-αR1a, and GDF-15 showed the strongest interaction between sex and mortality.
Conclusion
Female heart failure patients have a distinct clinical presentation and better outcomes compared with male patients. The lower mortality was independent of differences in clinical characteristics, but differential sex associations between several biomarkers and mortality might partly explain the survival difference.