摘要
目的观察比较泼尼松联用硫唑嘌呤和大剂量静脉用免疫球蛋白(IVIG)对扩张型心肌病(DCM)患儿心功能及预后的影响。方法将DCM患儿20例分为治疗Ⅰ和Ⅱ组,分别在传统抗心衰治疗基础上加泼尼松联用硫唑嘌呤和大剂量IVIG,治疗1个疗程后评价心功能,检测治疗前后左房横径(LA)、左室舒张期内径(LV)、左室射血分数(LVEF)、心脏指数(CI),并计算其治疗前后变化。所有病例随访1年,计算1年存活率。结果治疗Ⅱ组心功能明显优于治疗Ⅰ组(P均<0.05);两组LA、LV、LVEF和CI治疗后较治疗前均有明显改善(P均<0.05);治疗Ⅰ组各参数变化明显低于治疗Ⅱ组(P均<0.05),其1年存活率明显低于治疗组Ⅱ(P<0.05)。结论泼尼松联用硫唑嘌呤和大剂量IVIG均能改善DCM患儿心功能,但IVIG疗效优于泼尼松联用硫唑嘌呤。
Objective To compare the heart function and observe the clinical prognosis of dilated cardiomyopathy（DCM） in children treated with combination of prednisone and azathioprine and high dose intravenous immunoglobulin（IVIG）. Methods From Jan. 1998 to May 2004,20 children who met the diagnostic criteria of DCM were divided into 2 therapeutic groups（group Ⅰ , group Ⅱ） according to the time of hospitalization. On the basis of traditional congestive heart failure（CHF） therapy, the children in group I were treated with immunosuppressive therapy（prednisone plus azathioprine） and the children in group Ⅱ were treated with high dose IVIG. The course of treatment was 6 months for all children. Heart functions in all children were evaluated and echocardiographic parameters including left auricular diameter（LA）, left ventricular end diastolic diameter（LV）, left ventricular ejection fraction（LVEF） and cardiac index （ CI ） were measured before and after therapy, respectively. All children were followed up for 1 year to observe survival rate（ 96 ）. The findings were analyzed by t test and χ^2 test. Results The percentage of heart function increased from Ⅲ - Ⅳto Ⅰ- Ⅱin group I , which was lower than that in group Ⅱ（P〈0.05）. The echocardiographic parameters of all children in two groups were improved significantly after treatment as compared with that before treatment （all P〈0.05） ; The changes of these parameters in group Ⅱ were higher than that in group Ⅰ .There was significant difference between group Ⅰ and group Ⅱ （P〈 0.05）. The follow - up findings demonstrated that the survival rate of group Ⅰ was lower than that of group Ⅱ （P〈0.05）. Conclusions These findings indicate that both prednisone plus azathioprine and high dose IVIG can improve heart function of children with DCM, but the therapeutic effect of IVIG is better than that of prednisone plus azathioprine. Our observations confirm that the clinical prognosis of DCM with IVIG is sat
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2006年第13期837-838,共2页
Journal of Applied Clinical Pediatrics
关键词
心肌病
扩张型
免疫治疗
心功能
存活率
儿童
dilated cardiomyopathy
immunotherapy
heart function
survival rate
child
