扩张型心肌病与冠心病心功能不全患者的临床特征分析

The analysis of clinical characters between the patients of dilated cardiomyopathy and the patients of coronary heart disease with cardiac insufficiency

目的:分析比较扩张型心肌病(DCM)与冠心病(CHD)心功能不全患者[缺血性心肌病(ICM)患者与左心室扩大而不伴陈旧性心肌梗死(OMI)的患者]的临床特征。方法:DCM患者67例,ICM患者350例,不合并OMI而左心室显著扩大的CHD患者289例。记录所有患者入院后的基本生命体征、各种合并症、肾功能、血脂、空腹血糖、胰岛素以及超声心动图等。结果:(1)DCM患者的男性比例(82.1%)最高而脑血管意外患病率(1.5%)最低,且其饮酒率、频发室性早搏、心房纤颤以及二尖瓣返流情况也比较严重。ICM患者糖尿病患病率最高(35.7%)。不伴OMI的CHD患者的高血压患病率最高(76.8%)。(2)配伍后各区组患者间比较,不伴OMI的CHD患者的室间隔平均水平明显厚于而射血分数平均水平明显高于DCM和ICM患者,且其左心房直径平均水平明显小于DCM患者。各组患者之间的临床生化指标比较差异无统计学意义。结论:DCM患者、ICM患者与不伴OMI的CHD患者在心脏结构与临床生化方面差异较小,但前两者的左心室收缩功能与预后远差于后者。

Objective： To study the differences of the clinical characteristics among the patients of the dilated cardiomyopathy （DCM）,the ischemic cardiomyopathy （ICM）and the coronary heart disease （CHD） with dilated left ventricles without old myocardial infarction （OMI）. Methods： 67 subjects with DCM, 350 subjects with ICM and 289 subjects with CHD without OMI with dilated left ventricles were enrolled in the study. The physical examination, complication, blood urea nitrogen, serum creatine, albumin, fasting blood glucose, insulin, cholesterol, triglycride and ultrasound cardiography were recorded in all the patients. Results： （1）The ratio of male （82.1%）in the patients with DCM was higher while the ratio of cerebrovascular accident （1.5%） was lower than those in the other two kinds of patients. The ratio of drinking, atrial fibrillation, frequent ventricular premature systole and the mitral regurgitation were a little worse in the patients with DCM. The ratio of diabetes in the patients with ICM was the highest in all the patients. The ratio of hypertension in the patients with CHD uncomplicated OMI was higher than that in the other two kinds of patients. （2）With the analysis of randomized block design analysis of variance, the level of interventricular septum and ejection fraction of the patients with CHD uncomplicated OMI were higher than those in the other two kinds of patients, while the level of atrial dimension of the patients with CHD uncomplicated OMI was lower than that in the patients of DCM. There was no difference in the laboratory examinations of all the patients. Conclusion： There is little difference among the patients with DCM, ICM and CHD uncomplicated OMI in the structure of heart and the clinical characteristics. However, the left ventricular systolic function and the prognosis of the patients with DCM and ICM are both worse than that of patients with CHD uncomplicated OMI.