儿童新发扩张型心肌病药物治疗后左心室逆重构发生率及预测因素  

Prevalence and predictors of left ventricular reverse remodeling after drug therapy in children with new-onset dilated cardiomyopathy

作　　者：潘宇 刘晓燕[1] PAN Yu;LIU Xiaoyan(Department of Cardiology,Children's Hospital of Chongqing Medical University,Ministry of Education Key Laboratory of Child Developmental Disorder,National Clinical Research Center for Child Health and Disorders,China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院心血管内科,儿童发育疾病研究教育部重点实验室,国家儿童健康与疾病临床医学研究中心,儿童发育重大疾病国家国际科技合作基地,儿科学重庆市重点实验室,重庆400014

出　　处：《临床儿科杂志》2020年第11期851-856,共6页Journal of Clinical Pediatrics

摘　　要：目的探讨儿童新发扩张型心肌病药物治疗后左心室逆重构的发生率及预测因素。方法回顾分析2012年2月至2018年11月住院治疗的新发扩张型心肌病、心内膜弹力纤维增生症并随访至2020年1月或死亡的55例患儿的临床资料,患儿住院及出院后均给予标准药物治疗。根据随访复查的超声心动图结果,定义随访时左心室射血分数(LVEF)较基线提高≥10%且LVEF≥55%,同时经体表面积标准化后的左心室舒张末期内径Z值(LVEDD-Z)较基线降低≥10%且LVEDD-Z≤2为达到左心室逆重构,调查左心室逆重构发生率。收集患儿首次入院时的临床和超声心动图等指标,采用多元logistic回归方法分析左心室逆重构的基线预测指标。结果55例患儿中,男16例、女39例,发病年龄中位数7个月(范围23天~13岁2个月)。超声心动图中位随访33个月(范围1~85个月)后,25例患儿发生左室逆重构,其LVEF由入院时(37.1±7.4)%提高至随访时(65.7±5.4)%,LVEDD-Z由(9.5±3.0)降低至随访时的(1.3±0.6),差异均有统计学意义(P<0.001)。单因素logistic回归分析显示,肺动脉高压、中重度三尖瓣反流、血清白蛋白水平与儿童新发扩张型心肌病发生左室逆重构相关。多元logistic回归分析显示,无中重度三尖瓣反流是儿童新发扩张型心肌病发生左室逆重构的独立预测因素(OR=9.75,95%CI:1.03~87.62,P<0.05)。结论近半数儿童新发扩张型心肌病经药物治疗后可发生左室逆重构,无中重度三尖瓣反流患儿发生左室逆重构的可能性大。Objective To explore the prevalence and predictors of left ventricular reverse remodeling after drug therapy in children with new-onset dilated cardiomyopathy.Methods The clinical data of new-onset dilated cardiomyopathy and endocardial fibroelastosis were retrospectively analyzed in 55 children who were hospitalized from February 2012 to November 2018 and were followed up to January 2020 or death.The standard drug treatment was given to the children after hospitalization and discharge.Left ventricular inverse remodeling was defined as an increase in left ventricular ejection fraction(LVEF)by≥10%from baseline and LVEF≥55%during follow-up,and at the same time a decrease by≥10%in left ventricular enddiastolic dimension z score(LVEDD-Z)after body surface area standardization from baseline and LVEDD-Z≤2.The incidence of left ventricular inverse remodeling was investigated according to echocardiography results.The clinical and echocardiographic findings were collected at children's first admission.The baseline predictors of left ventricular reverse remodeling were analyzed by multivariate logistic regression.Results There were 55 children(16 males and 39 females)with a median age of 7 months(range:23 days to 13 years and 2 months).After a median follow-up of 33 months(range 1~85 months),25 children were found to have left ventricular reverse remodeling by echocardiography.The LVEF increased from(37.1±7.4)%at admission to(65.7±5.4)%at follow-up,LVEDD-Z decreased from(9.5±3.0)at admission to(1.3±0.6)at follow-up,and the differences were statistically significant(P<0.001).Univariate logistic regression analysis showed that pulmonary hypertension,moderate to severe tricuspid regurgitation and serum albumin level were associated with left ventricular reverse remodeling in new-onset dilated cardiomyopathy in children.Multivariate logistic regression analysis showed that neither moderate nor severe tricuspid regurgitation was an independent predictor of left ventricular reverse remodeling in recent-onset dilated

关 键 词：扩张型心肌病 心内膜弹力纤维增生症 左心室逆重构 药物治疗 儿童 

分 类 号：R725.4[医药卫生—儿科]