扩张型心肌病并完全性左束支阻滞患儿左心室射血分数的中短期变化及相关心电图指标的预测价值  

Short-term and medium-term changes of the left ventricular ejection fraction in children with dilated cardiomyopathy complicated with complete left bundle branch block and the predictive value of relevant electrocardiogram indexes

作　　者：张砚茹 丁文虹[2] 王本臻[1] 戴辰程[2] 肖燕燕[2] 单光颂 韩玲[2] 李自普[1] Zhang Yanru;Ding Wenhong;Wang Benzhen;Dai Chencheng;Xiao Yanyan;Shan Guangsong;Han Ling;Li Zipu(Department of Pediatric Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Heart Center,Women and Children′s Hospital,Qingdao University,Qingdao 266034,China)

机构地区：[1]青岛大学附属妇女儿童医院心脏中心,青岛266034 [2]首都医科大学附属北京安贞医院小儿心脏科,北京100029

出　　处：《中华实用儿科临床杂志》2022年第7期510-515,共6页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨扩张型心肌病(DCM)并完全性左束支阻滞(CLBBB)患儿左心室射血分数(LVEF)的中短期变化及相关心电图指标的预测价值。方法回顾性分析2011年11月至2020年8月青岛大学附属妇女儿童医院心脏中心和首都医科大学附属北京安贞医院临床确诊为DCM的患儿,根据是否有CLBBB将DCM患儿分为合并CLBBB组(CLBBB组)和未合并CLBBB组(non-CLBBB组)。所有患儿定期行超声心动图和心电图检查,根据随访1~5年的数据,比较两组患儿LVEF的中短期变化特点,并应用COX比例风险模型及Kaplan-Meier乘积极限法探索心电图相关指标预测DCM合并CLBBB患儿LVEF变化的价值。结果94例DCM患儿纳入本研究,其中CLBBB组35例,non-CLBBB组59例。CLBBB组和non-CLBBB组的LVEF基线值比较差异无统计学意义(P>0.05),但2组患儿的QRS时限、纠正的QT间期(QTc)、V5导联R波峰值时间(TV5R)及QRS波切迹或顿挫异常比较差异均有统计学意义(均P<0.05)。DCM患儿的LVEF在发病1年内呈上升趋势,左心室舒张末期内径(LVEDd)Z值呈下降趋势,并于1~5年内趋于稳定;且CLBBB组患儿的LVEDd Z值显著高于non-CLBBB组,差异有统计学意义(P<0.05)。CLBBB组患儿的LVEF均值围绕50%小幅度波动,而non-CLBBB组患儿的LVEF均值于60%上下浮动,CLBBB组患儿的LVEF均值显著低于non-CLBBB组,差异有统计学意义(P<0.05)。多变量COX回归分析显示患儿QRS时限(HR=0.979;95%CI:0.960~0.999,P<0.05)和QTc(HR=0.988;95%CI:0.979~0.998,P<0.05)是DCM患儿LVEF恢复正常的独立预测因子。Kaplan-Meier乘积极限法显示不同水平QRS时限和QTc的DCM患儿LVEF正常化率的差异有统计学意义(P<0.05)。结论DCM并CLBBB患儿LVEF经规范治疗后短期内上升,后趋于稳定;CLBBB影响DCM患儿左心室功能的恢复;心电图指标QRS时限和QTc是预测DCM患儿LVEF恢复正常的独立预测因子。Objective To investigate the short-term and medium-term changes of the left ventricular ejection fraction(LVEF)and the predictive value of relevant electrocardiogram(ECG)indexes in children with dilated cardiomyopathy(DCM)complicated with complete left bundle branch block(CLBBB).Methods Children clinically diagnosed with DCM in the Department of Heart Center,Women and Children′s Hospital,Qingdao University and Beijing Anzhen Hospital,Capital Medical University between November 2011 and August 2020 were retrospectively recruited.According to the combination of CLBBB,they were divided into CLBBB group and non-CLBBB group.Echocardiogram and ECG were regularly performed.Short-term and medium-term changes of LVEF based on the 1-5-year follow-up data were compared between groups.COX proportional hazards model and Kaplan-Meier multiplicative limit method were used to analyze the predictive value of ECG indexes of LVEF changes in children with DCM combined with CLBBB.Results Ninety-four children with DCM were enrolled,including 35 cases in CLBBB group and 59 cases in non-CLBBB group.There was no difference in baseline LVEF between groups.However,significant differences were found in QRS duration,corre-cted QT interval(QTc),R peak time in lead V5(TV5R)and QRS notching or slurring between groups(P<0.05).LVEF of all children showed an upward trend within one year after onset,while the Z value of eft ventricular end diastolic diameter(LVEDd)showed a downward trend,and the two indexes tended to be stable within 1-5 years.The Z value of LVEDd in CLBBB group was significantly higher than that of non-CLBBB group,while LVEF was significantly lower(all P<0.05).The mean LVEF of CLBBB group slightly fluctuated around 50%,that of LVEF in non-CLBBB group was 60%.The multivariate COX regression analysis showed that QRS duration(HR=0.979;95%CI:0.960-0.999,P<0.05)and QTc(HR=0.988;95%CI:0.979-0.998,P<0.05)were independent predictors of LVEF recovery in children with DCM.Kaplan-Meier method showed a significant difference of LVEF normali

关 键 词：扩张型心肌病 完全性左束支阻滞 左心室射血分数 心电图 

分 类 号：R725.4[医药卫生—儿科]