原发性扩张型心肌病左心室逆重构的预测因素  

Predictors of left ventricular reverse remodeling in dilated cardiomyopathy

作　　者：宗敏[1] 关晓楠[1] 张建军[1] ZONG Min;GUAN Xiaonan;ZHANG Jianjun(Department of Cardiology,Affiliated Beijing Chaoyang Hospital of Capital Medical University,Beijing,100043,China)

机构地区：[1]首都医科大学附属北京朝阳医院心内科,北京100043

出　　处：《临床心血管病杂志》2021年第9期846-849,共4页Journal of Clinical Cardiology

摘　　要：目的:探讨原发性扩张型心肌病(DCM)出现左心室逆重构(LVRR)的影响因素。方法:顺序入选2011年1月—2017年10月于首都医科大学附属北京朝阳医院心内科首次住院的原发性DCM患者,其中左心室射血分数(LVEF)<40%的患者纳入研究,随访时间2年。以首次住院超声心动图LVEF为基础,以末次复查时LVEF≥40%且较基线值增加10%以上为LVRR组,其余患者为NLVRR组。通过调取住院及门诊资料,采取门诊面访、电话随访等方式,分析患者的临床生化资料及心脏超声结果。对有统计学意义的临床资料进一步行多因素Logistic分析,探讨影响LVRR的预测因素。结果:研究共纳入符合条件的原发型DCM患者70例,其中出现LVRR的患者45例,LVRR发生率64%,LVRR组的BMI值、LVEF值、血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂使用率高于NLVRR组,左束支传导阻滞(LBBB)比例、心率、出院N末端利钠肽前体值、病程、左室舒张末期内径(LVEDD)值低于NLVRR组(P<0.05)。对有统计学差异的因素进一步行多因素Logistic回归分析,影响LVRR的独立预测因素为DCM家族史(OR=0.041,95%CI 0.003~0.53,P=0.014)、LBBB(OR=0.123,95%CI 0.026~0.588,P=0.011)、LVEDD<65mm(OR=10.058,95%CI 1.067~32.420,P=0.044)、LVEF≥35%(OR=6.612,95%CI 1.349~0.53,P=0.020),对上述4个独立预测因子进行联合因子受试者特征工作曲线分析并计算其曲线下面积(AUC),联合因子预测LVRR的敏感性为82.22%,特异性为92%,AUC为0.920。结论:DCM家族史、LBBB、LVEF≥35%及LVEDD<65mm为原发型DCM患者LVRR的独立预测因素,联合因子对预测LVRR有较好的敏感性及特异性。Objective:To explore the influential factors of left ventricular reverse remodeling(LVRR)in patients with primary dilated cardiomyopathy(DCM).Methods:Patients with primary DCM hospitalized for the first time were enrolled in the Department of Cardiology,Beijing Chaoyang Hospital Affiliated to Capital Medical University during January 2011to October 2017.Patients with left ventricular ejection fraction(LVEF)<40%were enrolled.After following up two years,the patients with LVEF≥40%and more than 10%higher than baseline at the last review(before the deadline)were divided into LVRR group and NLVRR group.The clinical biochemical data and cardiac ultrasound results of the patients were analyzed by outpatient interview and telephone follow-up.Multivariate Logistic analysis was performed to explore the independent predictors of LVRR.Results:A total of 70patients with DCM were included in the study,including 45patients with LVRR.The incidence of LVRR was 64%.The value of BMI and LVEF,ACEI/ARB utilization rate of LVRR group were higher than those of NLVRR group,while the LBBB ratio,the value of HR and NT pro-BNP,course of disease,LVEDD were lower than those of NLVRR group(P<0.05).The independent predictors of LVRR were family history(OR=0.041,95%CI:0.003-0.53,P=0.014),LBBB(OR=0.123,95%CI:0.026-0.588,P=0.011),LVEDD<65mm(OR=10.058,95%CI:1.067-32.420,P=0.044)and LVEF≥35%(OR=6.612,95%CI:1.349-0.53,P=0.020),The area under the ROC curve was 0.920.The sensitivity and specificity of the combined predictors were 82.22%and 92%respectively.Conclusion:Family history of DCM,LBBB,LVEF≥35%and LVEDD<65mm were independent predictors of LVRR in patients with DCM.Combined predictors have good sensitivity and specificity.

关 键 词：原发性扩张型心肌病 左心室逆重构 预测因素 

分 类 号：R542.2[医药卫生—心血管疾病]