摘要
目的探讨儿童扩张型心肌病（DCM）的临床特点及预后相关因素。方法采用回顾性病历调查方法，总结分析2007年5月至2011年11月武汉市儿童医院45例DCM患儿的临床资料。男27例，女18例；发病年龄为（19．20±18．98）个月。心功能Ⅰ-Ⅱ级（Ⅰ～Ⅱ级组）8例（17．8％），心功能Ⅲ～Ⅳ级（Ⅲ-Ⅳ级组）37例（82．2％）。将随访6个月-2年后左心室射血分数（LVEF）及左心室缩短分数（LVFS）较治疗前提高10％-15％的患儿设为好转组，LVEF及LVFS持续下降及死亡的患儿设为恶化组。好转组34例；恶化组8例，其中5例死亡。分析2组确诊年龄、异常Q波发生情况、心功能分级、LVEF和LVFS的差异。结果心功能Ⅲ～Ⅳ级组患儿心肌钙蛋白、肌酸激酶、肌酸激酶同工酶明显高于Ⅰ～Ⅱ级组，差异均有统计学意义（P均〈0．01）。确诊时有11例患儿心电图提示有异常Q波。LVEF、LVFS在心功能Ⅰ-Ⅱ级组明显高于心功能Ⅲ～Ⅳ级组，差异均有统计学意义（P均〈0．05）。好转组与恶化组在发病确诊年龄、初诊年龄≤1岁比例、异常Q波发生情况、心功能Ⅲ-Ⅳ级发生例数、LVEF、LVFS方面，差异均有统计学意义（P均〈0．05）。结论儿童DCM确诊时≤1岁最多，心功能多为Ⅲ～Ⅳ级。异常Q波发生情况、心功能级数、LVEF及LVFS值可作为判断预后的重要指标。
Objective To discuss the clinical features and prognostic factors in the children with dilated car- diomyopathy（DCM）. Methods The clinical data of 45 cases of DCM,including 27 boys and 18 girls, from May 2007 to Nov. 2011 in Wuhan Children＇s Hospital were analyzed by retrospective medical record survey methods. The average age of onset was（ 19.20 ＋ 18.98） months. Eight cases （ 17.8% ） were of cardiac function gradeⅠ-Ⅱ, and 37 cases （82.2%） were of cardiac function grade Ⅲ -Ⅳ. The patients whose left ventricular ejection fraction （LVEF） and left ventricular fractional shortening （LVF$） increased by 10% - 15% compared with those before treatment were defined as improved group, and the patient＇s LVEF and LVFS levels declined persistently or those of dead cases were defined as worsened group. There were 34 cases assigned as the improved group,8 cases as the worsened group, and 5 out of 8 ca- ses were dead. The age, occurrence of abnormal Q waves, cardiac function, LVEF and LVFS in the 2 groups were ana- lyzed. Results The eardiac troponin, creatine kinase, creatine kinase isoenzyme in the cardiac function grade Ⅲ～Ⅳ group were significantly higher than those in the cardiac function grade Ⅰ-Ⅱ The LVEF and LVFS levels in the cardiac function grade I - II group were significantly higher than those in the cardiac function grade Ⅲ～Ⅳ group （ all P 〈 O. 05 ）. There were statistically significant differences in age on diagnosed, proportion of newly diagnosed cases age ~ 1 year old, occurrence of abnormal Q waves, cardiac function in grade Ⅲ～Ⅳ, LVEF and LVFS levels between the improved group and the worsened group （ all P 〈 0.05 ）. Conclusions Most of the children with DCM were diag- nosed more when they were ≤ 1 year old, mostly with cardiac function grade Ⅲ～Ⅳ. The occurrence of abnormal Q waves, cardiac function grade, LVEF and LVFS levels could be used as important prognostic indicators for DCM.
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2013年第24期1881-1883,共3页
Chinese Journal of Applied Clinical Pediatrics
关键词
扩张型心肌病
异常Q波
心功能分级
左心室射血分数
左心室缩短分数
Dilated cardiomyopathy
Abnormal Q waves
Cardiac function
Left ventricular ejection fraction
Left ventricular shortening fraction
