儿童心动过速性心肌病临床特征和预后影响因素分析  

Retrospective analysis of clinical profile and predictors of prognosis in pediatric tachycardia-induced cardiomyopathy

作　　者：韩晓华[1] 王凤[1] 吴琳[1] 田宏[1] 梁雪村[1] 刘芳[1] 

机构地区：[1]复旦大学附属儿科医院心血管中心,上海201102

出　　处：《中国循证儿科杂志》2016年第2期126-130,共5页Chinese Journal of Evidence Based Pediatrics

基　　金：上海市卫生和计划生育委员会面上项目:201440631

摘　　要：目的探讨儿童心动过速性心肌病(TIC)的临床特征、药物疗效以及预后。方法回顾性收集复旦大学附属儿科医院出院诊断中各种类型的快速型心律失常且左室短轴缩短率(LVFS)<30%的病历,采集临床表现、抗心律失常治疗、心电图和超声心动图评估以及生物标志物。临床随访终点定义为LVFS≥30%和标化左室舒张末期内径(Z-LVEDD)<2.0。采用多元线性回归和Logistic回归分析心肌病变恢复的可能影响因素。结果 2003年5月至2016年1月56例TIC患儿进入本文分析,男37例(66.1%),<1岁婴儿40例(71.4%)。房性心动过速(53.6%)与阵发性室上性心动过速(37.5%)是儿童TIC最常见的心律失常类型。所有患儿均接受抗心律失常药物治疗,有效29例(51.8%),部分有效23例(41.1%),无效4例(7.1%);乙胺碘呋酮是最常被选用(69.6%)的抗心律失常药物,单独或联合使用的总有效率达92.3%(36/39)。除外2例死亡病例,54例TIC患儿LVFS治疗前[(23.7±3.7)%]和治疗后[(32.8±4.6)%]差异有统计学意义(P<0.001);Z-LVEDD治疗前(2.79±3.04)和治疗后(0.37±2.0)差异有统计学意义(P<0.001);LVFS与ZLVEDD达到随访终点定义的中位时间分别10 d和42 d。氨基末端B型钠尿肽原治疗前[(15 711±11 453)pg·mL^(-1)]和治疗后[(1 287±1 510)pg·mL^(-1)]差异有统计学意义(P<0.001)。多元线性回归分析显示,治疗前Z-LVEDD越小,越利于Z-LVEDD早期恢复(β=0.528,95%CI:0.127~0.506,P=0.002)。结论儿童TIC心动过速有效控制后,心肌功能可部分或完全恢复。临床医生的早期识别与有效治疗对于儿童TIC的预后具有重要意义。Objective To illustrate the clinical features,efficiency of anti-arrhythmic medications and prognosis in pediatric tachycardia-induced cardiomyopathy（ TIC）. Methods Retrospective review of medical records was carried out in children with TIC,and defined as LVFS 30% associated with various tachyarrhythmia in Children＇s Hospital of Fudan University. Data with respect to the clinical findings,anti-arrhythmic therapy,electrocardiographic and echocardiographic evaluation and biomarkers were collected. Clinical follow-up was continued until both LVFS ≥30% and Z-LVEDD 〉2. 0 were achieved. Multivariate linear and logistic regression analysis was performed to evaluate possible predictors of time to myocardial recovery. Results A total of 56 pediatric cases with TIC were included in our study from May 2003 to January 2016. Forty patients（ 71. 4%） were infants and 37 were boys（ 66. 1%）. Atrial tachycardia and paroxysmal supraventricular tachycardia were the most common types of responsible tachyarrhythmia,with the percentage of 53. 6% and 37. 5%,respectively. Anti-arrhythmic medications as part of management were used in all 56 cases and complete,partial and none effective response to medications occurred in 29（ 51. 8%）,23（ 41. 1%） and4（ 7. 1%） cases,respectively. Amiodarone was the most commonly used medication,and its effectiveness was achieved in 92. 3%（ 36 /39） children,including both used alone and in combination with other medications. Except for 2 cases of death,left ventricular fractional shortening（ LVFS） was significantly increased from（ 23. 7 ± 3. 7） % to（ 32. 8 ± 4. 6） %（ P 〈0. 001）,and Z-LVEDD was decreased from（ 2. 79 ± 3. 04） to（ 0. 37 ± 2. 0）（ P 〈0. 001） in the remaining 54 cases. Median time for recovery of LVFS and Z-LVEDD was 10 days and 42 days,respectively. Plasma（ N-terminal） pro B-type natriuretic peptide was reduced significantly from（ 15 711 ± 11 453） pg·mL^（-1）to（ 1 287 ± 1 510） pg·mL^（-1）（ P 〈0. 001�

关 键 词：心动过速性心肌病 快速型心律失常 儿童 

分 类 号：R725.4[医药卫生—儿科]