17例围产期心肌病的临床特点和随访分析  

Clinical features and follow-up analysis of 17 cases of peripartum cardiomyopathy

作　　者：张海华 俞梦越 Zhang Haihua;Yu Mengyue(Premium Center, Fuwai Hospital, Chinese Academy of Medical Science, Beijing 100037, China)

机构地区：[1]中国医学科学院阜外医院特需医疗中心,北京100037

出　　处：《中国心血管杂志》2021年第1期27-31,共5页Chinese Journal of Cardiovascular Medicine

基　　金：国家自然科学基金项目(81670415)。

摘　　要：目的研究围产期心肌病的临床特点。方法回顾性分析2009—2017年在阜外医院住院并有随诊记录的17例围产期心肌病患者的临床资料。其中,13例患者进行了磁共振钆延迟强化(LGE),分为LGE阳性和阴性组,比较预后差异。结果17例围产期心肌病患者的中位年龄26岁(19~38岁),≥30岁6例(35.3%),妊娠≥2次8例(47.1%),分娩≥2次4例(23.5%),分娩前发病9例(52.9%)。我院初诊时平均左室射血分数33.3%±8.9%,左心室附壁血栓6例(35.3%),室性期前收缩7例(41.2%),其中合并短阵室性心动过速4例(23.5%)。住院期间均接受利尿剂和β受体阻滞剂治疗,14例(82.3%)接受血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂治疗,14例(82.3%)接受地高辛治疗。中位随访时间(距初次发病)25(13,48)个月,病情恢复5例(29.4%)。LGE阳性组病情恢复比例为0(0/6),阴性组病情恢复比例为71.4%(5/7),两组比较差异有统计学意义(P=0.021)。结论围产期心肌病合并左心室附壁血栓和室性心律失常较为常见,LGE检查对判断预后有帮助。Objective To explore the clinical characters of peripartum cardiomyopathy.Methods Seventeen patients with peripartum cardiomyopathy hospitalized in our hospital from 2009 to 2017 with follow-up records were selected and their clinical data and follow-up records were retrospectively analyzed.The patients who underwent magnetic resonance late gadolinium enhancement(LGE)were further analyzed and divided into LGE positive and LGE negative groups to compare the prognostic differences.Results The median age of 17 patients was 26 years old(19-38),6(35.3%)were≥30 years old,8(47.1%)were≥2 pregnancies,4(23.5%)were multiparous,and 9(52.9%)of predelivery patients.At the first visit in our hospital,left ventricular ejection fraction was 33.3%±8.9%.There were 6 cases(35.3%)of left ventricular thrombosis,7 cases(41.2%)of premature ventricular contraction,and 4 cases(23.5%)of non-sustained ventricular tachycardia.All were treated with diuretics and beta blockers during hospitalization,14(82.3%)were treated with angiotensin-converting enzyme inhibitor/angiotensin receptor antagonist,and 14(82.3%)were treated with digoxin.The patients were followed up for median 25(13,48)months after the onset of the disease,and 5 patients(29.4%)recovered.The recovery rate was 0 in the LGE positive group and 71.4%in the negative group(P=0.021).Conclusions Peripartum cardiomyopathy combined with left ventricular thrombus and ventricular arrhythmia is common,and LGE examination is helpful to determine the prognosis.

关 键 词：围产期心肌病 左室射血分数 左心室附壁血栓 磁共振成像 钆延迟强化 

分 类 号：R54[医药卫生—心血管疾病]