围产期心肌病的预后影响因素  

Analysis of prognostic factors of perinatal cardiomyopathy

作　　者：亓西美 杜洋 张萍萍[1] 王冬梅[1] 杜波[1] QI Xi-mei;DU Yang;ZHANG Ping-ping;WANG Dong-mei;DU Bo(Taian Central Hospital,Taian 271000,China)

机构地区：[1]泰安市中心医院心内科,山东泰安271000

出　　处：《泰山医学院学报》2021年第1期31-36,共6页Journal of Taishan Medical College

基　　金：泰安市科技发展计划(2019NS201)。

摘　　要：目的通过研究围产期心肌病的临床特点,为围产期心肌病的诊断和治疗提供参考依据。方法回顾性分析2008年1月至2019年5月间,在我院诊断为围产期心肌病共34例住院患者的临床资料、检查结果、诊治过程、疾病转归及随访1~114个月的记录。根据复查左室舒张末内径(left ventricular end diastolic diameter,LVED)是否恢复正常(≤50 mm)、左心室射血分数(left ventricular ejection fraction,LVEF)是否恢复正常(≥50%),将患者分为治愈组和未愈组。其中23例(68%)患者治愈为治愈组,年龄(30.6±7.2)岁,体重指数(29.0±2.1)kg/m^2,首次诊断时LVEF为(40.2±9.2)%,LVED为(58.0±6.5)mm;11例(32%)患者未治愈为未愈组,年龄(34.2±5.6)岁,体重指数(35.6±1.9)kg/m^2,首次诊断时LVEF为(30.9±10.2)%,LVED为(65.0±6.3)mm。比较两组的临床特点、辅助检查结果、治疗方案及转归情况。结果治愈组与未愈组在既往史、年龄、发病时间(孕期或剖宫产术后)、术后发病时间、血压、心率、血红蛋白、血糖、C反应蛋白、促甲状腺激素、肌酸激酶、肌酸激酶同工酶、N端脑钠肽前体(NT-proBNP)、尿酸、肺动脉压、应用血管紧张素转化酶抑制剂(ACEI)或血管紧张素II受体拮抗剂(ARB)、β受体阻滞剂、地高辛方面差异均无统计学意义(P>0.05),治愈组较未愈组体重指数低(t=8.940,P<0.001)、胎次(P<0.001)及胎数(P<0.001)少,肌钙蛋白高(Z=2.024,P=0.043)、尿蛋白少(P=0.002),左室舒张末内径偏小(t=2.965,P=0.006),LVEF偏高(t=2.633,P=0.012),二尖瓣返流(P<0.001)、胸腔积液(P<0.001)程度轻,应用溴隐亭比例高(P<0.001)。结论肥胖、多胎孕妇、经产妇、肌钙蛋白、尿蛋白、左室舒张末内径、LVEF、二尖瓣返流、胸腔积液、应用溴隐亭治疗是疾病转归的影响因素,其中左室舒张末内径≥63 mm提示预后欠佳。Objective:To determine predictors and indicators of clinical outcomes of patients with peripartum cardiomyopathy(PPCM).Methods:The retrospective study was conducted from January 2008 to May 2019 at our Hospital.Forty-four cases were collected and followed up for 1-114 months.Recovery was defined as a left ventricular end diastolic diameter(LVEDD)of no more than 50 mm and a left ventricular ejection fraction(LVEF)of no less than 50%.Persistent left ventricular dysfunction was defined as a LVEDD of more than 50mm and LVEF of less than 50%at the end of follow-up.The clinical characteristics,treatment protocols and outcomes of the patients were compared.Results:In this study,the estimated incidence of PPCM was approximately 1/1710,44 cases were collected and followed up for 1-114 months.34 of all the patients completed the follow-up.23(68%)cases recovered and 11(32%)did not.The average age of 23(68%)was(30.6±7.2)years old.Their body mass index(BMI)was(29.0±2.1)kg/m^2.The LVEF at diagnosis was(40.02±9.2)%,and the LVEDD was(58.0±6.5)mm.The average age of 11(32%)was(34.2±5.6)years old.Their body mass index(BMI)was(35.6±1.9)kg/m^2.The LVEF at diagnosis was(30.9±10.2)%,and the LVEDD was(65.0±6.3)mm.(2)There was no significant difference in the past history,age,onset time,blood pressure,heart rate,hemoglobin,glucose,C reactive protein(CRP),thyroid stimulating hormone(TSH),creatine kinase(CK),creatine kinase isoenzymes(CKMB),NT-proBNP uric acid,pulmonary aterial systolic pressure(PASP)and the percentage of patients taking ACEI or ARB,β-blockers and Digoxin between the two groups(P>0.05).Compared with the control group,the recovery group had lower BMI(t=8.940,P<0.001),lesser parities(P<0.001),lesser number of fetus(P<0.001),higher cardiac troponins(Z=2.024,P=0.043),lesser proteinuria(P=0.002),smaller left ventricular(t=2.965,P=0.006),.higher left ventricular ejection fraction(t=2.633,P=0.012),lesser severity of mitral regurgitation(P<0.001)and pleural effusions(P<0.001)and higher bromocriptine(P<0.001).Conclusion:Hi

关 键 词：围产期心肌病 预后影响 左室舒张末内径 

分 类 号：R542.2[医药卫生—心血管疾病]