儿童扩张型心肌病心电图精准分析及其临床意义  

A PRECISE ANALYSIS OF DILATED CARDIOMYOPATHY IN CHILDREN BY ELECTROCARDIOGRAPHY AND ITS CLINICAL SIGNIFICANCE

作　　者：陈丽 丁粤粤[1] 许菊珍[1] 侯淼[1] 左梦颖 沈洁[1] 张建敏[1] 徐秋琴[1] 张帆 孙凌[1] CHEN Li;DING Yueyue;XU Juzhen;HOU Miao;ZUO Mengying;SHEN Jie;ZHANG Jianmin;XU Qiuqin;ZHANG Fan;SUN Ling(Department of Pediatric Cardiovascular,Children’s Hospital Affiliated to Soochow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属儿童医院心血管内科,江苏苏州215000

出　　处：《精准医学杂志》2018年第5期398-402,共5页Journal of Precision Medicine

基　　金：苏州市民生科技项目(SS201871)

摘　　要：目的精准分析儿童扩张型心肌病(DCM)诊断初期心电图(ECG)特征及其临床意义。方法我院2010年1月—2018年6月首诊并收治的确诊为DCM病儿47例,精准分析其诊断初期ECG改变与病儿左心室舒张末期内径(LVEDD)Z值、左心室射血分数(LVEF)、心功能分级、脑钠肽(BNP)及病情预后的关系。结果 47例DCM病儿ECG均有异常改变,其中ST-T改变最常见(占70.2%)。Z值>6组左心室增大的比例明显高于Z值≤6组,差异有统计学意义(χ2=7.892,P<0.05)。LVEF≤40%组左心室增大比例明显高于LVEF>40%组,差异有统计学意义(χ2=4.776,P<0.05)。DCM病儿ECG碎裂QRS波(fQRS)发生比例10.6%。未见QRS波时限和QT间期延长的改变。异常Q波、室内传导阻滞、完全性左束支传导阻滞各1例,室性期前收缩2例,均仅见于心功能Ⅳ级组、LVEF≤40%组和BNP>150ng/L组。随访19例,室内传导阻滞、完全性左束支传导阻滞出现在病情好转的病儿中。结论儿童DCM几乎均有ECG改变,改变的类型与成人DCM略有不同,ECG对于儿童DCM的发现、心肌病变和心功能严重程度的判断有一定临床价值,但对于其预后的判断价值尚不能确定。Objective To accurately analyze the electrocardiographic(ECG)features of children with dilated cardiomyo-pathy(DCM)at the initial stage of diagnosis and related clinical significance. Methods A total of 47 children who were admitted to our hospital from January 2010 to June 2018 and were diagnosed with DCM were enrolled.A precise analysis was performed to investigate the association of ECG changes at the initial stage of diagnosis with left ventri cular end-diastolic diameter(LVEDD)Z value,left ventricular ejection fraction(LVEF),cardiac functional grade,brain natriuretic peptide(BNP),and prognosis. Results All 47 children with DCM had abnormal ECG changes,among which ST-T change was the most common abnormality and accounted for 70.2%.The Z value>6 group had a significantly higher proportion of children with left ventricular enlargement than the Z≤6 group(χ2=7.892,P<0.05).The LVEF≤40%group had a significantly higher proportion of children with left ventri-cular enlargement than the LVEF>40%group(χ2=4.776,P<0.05).Of all DCM children,10.6%had fragmented QRS wave on ECG.There were no changes of prolonged QRS wave duration and QT interval.One child each had abnormal Q wave,intraventri-cular block,and complete left bundle branch block and two children had premature ventricular beats;all these children were in the gradeⅣcardiac function group,the LVEF≤40%group,and the BNP>150 ng/L group.Follow-up was performed for 19 children,and intraventricular block and complete left bundle branch block were observed in children with improvement. Conclusion Almost all children with DCM have ECG changes,and the type of change in children is slightly different from that in adults.ECG has a certain clinical value in identifying DCM in children,assessing the severity of myocardial lesions,and evaluating cardiac function,but its value in prognostic evaluation remains uncertain.

关 键 词：心肌病 扩张型 心电描记术 儿童 诊断 预后 

分 类 号：R725.422[医药卫生—儿科]