特发性扩张型心肌病合并缺血性卒中的临床特征、危险因素及预后  

Clinical features, risk factors and prognosis of idiopathic dilated cardiomyopathy complicated by ischemic stroke

作　　者：樊泽新 王朝斌 方丽波[3] 蔡宾 袁鹏[1] 牛天童 马琳 袁国宾 刘广志 Fan Zexin;Wang Chaobin;Fang Libo;Cai Bin;Yuan Peng;Niu Tiantong;Ma Lin;Yuan Guobin;Liu Guangzhi(Department of Neurology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Neurology,Liangxiang Hospital,Fangshan District,Beijing,Beijing 102400,China;Department of Neurology,Fuxing Hospital,Capital Medical University,Beijing 100045,China)

机构地区：[1]首都医科大学附属北京安贞医院神经内科,北京100029 [2]北京市房山区良乡医院神经内科,北京102400 [3]首都医科大学附属复兴医院神经内科,北京100045

出　　处：《中华医学杂志》2022年第45期3592-3597,共6页National Medical Journal of China

基　　金：国家自然科学基金(82071342)。

摘　　要：目的分析特发性扩张型心肌病(DCM)合并缺血性卒中(IS)的临床特点、危险因素及其预后。方法回顾性分析2016年1月至2020年12月首都医科大学附属北京安贞医院、北京市房山区良乡医院和首都医科大学附属复兴医院住院的613例特发性DCM患者的临床资料(其中合并IS者123例)。总结了特发性DCM患者合并IS的临床特点,采用多因素logistic回归模型分析特发性DCM合并IS的独立危险因素。对特发性DCM患者进行1年随访,以全因死亡和心脏移植为不良结局,采用Kaplan-Meier曲线描述患者的预后。结果在70例特发性DCM合并IS患者中发现,符合大动脉粥样硬化亚型者6例(8.6%,6/70)、心源性栓塞亚型者47例(67.1%,47/70)、小动脉闭塞亚型(即腔隙性梗死)者17例(24.3%,17/70)。高血压(OR=1.617,95%CI:1.049~2.491,P=0.029)、高血脂(OR=1.918,95%CI:1.198~3.073,P=0.007)、心房颤动(AF)(OR=1.617,95%CI:1.016~2.572,P=0.043)、估算肾小球滤过率(eGFR)低(OR=0.986,95%CI:0.977~0.996,P=0.005)以及心内血栓(OR=6.127,95%CI:3.174~11.827,P<0.001)是特发性DCM合并IS的危险因素。在特发性DCM合并IS患者中,1年的累积生存率(70.7%)(即未发生全因死亡/心脏移植)低于不合并IS者(83.6%,P=0.004),死因主要包括恶性心律失常(合并IS者3例、不合并IS者5例)、顽固性心衰(合并IS者22例、不合并IS者18例)。结论在特发性DCM合并IS的患者中,心源性栓塞最常见,其次是腔隙性梗死,大动脉粥样硬化亚型最少见;高血压、高血脂、AF,更低的eGFR值以及心内血栓是特发性DCM合并IS的危险因素;特发性DCM合并IS的短期预后差,顽固性心衰和恶性心律失常是其主要死因。Objective To analyze the clinical features,risk factors and prognosis of idiopathic dilated cardiomyopathy(DCM)complicated with ischemic stroke(IS)(DCM-IS).Methods The clinical data of patients with idiopathic DCM(n=613)in Beijing Anzhen Hospital,Liangxiang Hospital and Fuxing Hospital from January 2016 to December 2020 were retrospectively collected,and among them,123 cases were DCM-IS.Clinical features of patients with DCM-IS were summarized and multivariate logistic regression model was utilized to analyze the independent risk factors of DCM-IS.Furthermore,1-year follow-up was conducted and Kaplan-Meier curve was adopted to analyze the prognosis of DCM,using all-cause death and heart transplantation as adverse outcomes.Results Among the 70 patients with DCM-IS,6 patients(8.6%,6/70)were in accordance with the subtype of large artery atherosclerosis,and 47 patients(67.1%,47/70)were in line with the subtype of cardiogenic embolism,and small artery occlusion subtype(ie,lacunar infarction)were detected in 17 cases(24.3%,17/70).Hypertension[odds ratio(OR)=1.617,95%confidence interval(CI):1.049-2.491,P=0.029],hyperlipidemia(OR=1.918,95%CI:1.198-3.073,P=0.007),atrial fibrillation(AF)(OR=1.617,95%CI:1.016-2.572,P=0.043),lower estimated glomerular filtration rate(eGFR)(OR=0.986,95%CI:0.977-0.996,P=0.005)and a higher incidence of intracardiac thrombus(OR=6.127,95%CI:3.174-11.827,P<0.001)were risk factors for DCM-IS.The overall 1-year survival rate was lower in DCM-IS patients(70.7%)than DCM patients without stroke(83.6%,P=0.004),and the main causes of death included obstinate heart failure(3 cases of DCM-IS,and 5 cases of non-DCM-IS)and malignant arrhythmia(DCM-IS)(22 cases of DCM-IS,and 18 cases of non-DCM-IS).Conclusions Among IS patients with idiopathic DCM,cardioembolism is the most common,followed by lacunar infarction,and the large-artery atherosclerotic subtype is the least common.Hypertension,hyperlipidemia,AF,lower eGFR value and higher incidence of intracardiac thrombus are risk factors for DCM-IS.DCM patients

关 键 词：心肌病 扩张型 缺血性卒中 危险因素 预后 队列研究 

分 类 号：R542.2[医药卫生—心血管疾病] R743.3[医药卫生—内科学]