210例扩张型心肌病住院患者回顾性调查

The retrospective investigation of 210 inpatients with Dilated cardiomyopathy

目的:探讨近年来扩张型心肌病(DCM)的临床表现特点及预后。方法:回顾性分析2000年1月～2009年8月我院收治的210例DCM患者的临床资料以及其中157例(75%)的随访结果。结果:心功能MYHA1-Ⅱ级10例(5%),Ⅲ级心功能30例(14%),Ⅳ级者170例(81%),6例(3%)为家族性DCM。200例(99%)患者中有100例占48%的为心房纤顫,20例占10%的为多源性室性早搏,40例占19%的为短阵室性心功过速,左束枝传导阻滞70例(33%),完全性右束枝阻滞20例(10%),室性逸搏性心律2例(1%)。患者进行的B超检查:有65%的有左心房、左心室同时扩大,有85%的为全心扩大。比较得知左室舒张末期出现了增大,有统计学意义。进行治疗以后,患者的β受体阻滞剂使用率、血管紧张转换酶抑制剂为84例患者占40%,147例患者占70%。所有的210例患者里,随访了160例,时间为30±24个月。期间9例患者发生死亡,8例患者为心力衰竭致死,1例患者为猝死。患者的生存率为1年98%,2年95%,5年94%。比报道高很多,其中家族性DCM的患者6例的5年的生存率为67%,低于散发患者(6%),P<0.05。结论:家族性DCM的病人在确认后都出现有心脏扩大、心律失常的情况发生,治疗后都已经有了改善,这证明患者出现猝死、心力衰竭是主要的死亡的致病原因。

Objective：To explore the clinical features and prognosis of Dilated cardiomyopathy （DCM） in recent years. Methods：The clinical data of 210 cases of DCM and which 157 cases of follow - up results were analyzed retrospectively. Results ： 10 cases （5%） with Cardiac function MYHA1 - Ⅱ ,30 cases （ 14% ） with MY- HA1 - Ⅲ and 170 cases （81%） with MYHA1 - Ⅳ ,and 6 （3%） patients with familial DCM. 200 cases （99%） with various arrhythmias ,including 100 cases （48%） with atrial fibrillation,20 cases （ 10% ） with multi - derived premature ventricular contractions,40 cases （ 19% ） with merits and demerits of paroxysmal ventricular heart rate,70 cases （33 % ） with left bundle branch block, and 2 cases （ 1% ） with ventricular escape beat rhythm. The echocardlography indicated that 65% cases with left a- trium and left ventricle while expanding,65% cases with heart expanding. Comparing patients with Ⅱ - Ⅳ cardiac function with the patients with Ⅰ - Ⅱ ,the former Canon LV end - diastolic [ （67.8 ±8.2） ：（62.1 ±6.4） ] was significantly increased,and the Left ventricular ejection fraction [ （31.8 ±9.0）% ：（42.1 ± 11.0）% ] was significantly lower than the latter, P 〈 0.01. During the drug treatment, the usage of Angiotensin - converting enzyme inhibitors and β receptor blockers were 70% and 40% respectively. In all 210 inpatients, 160 cases were followed for 30 ± 24 months,in which 9 patients died （8 cases died for heart failure, 1 for sudden death）. If without cardiac transplantation, the 1 year,2 years and 5 years survival was 98% ,95 % and 94% respectively, which was higher than the previously domestic reports~ The 5 years survival of 6 cases of familial DCM （67 % ） was lower than the sporadic patient （ 6% ）, P 〈 0.05. Conclusion ： The cardiac function of patients with diagnosed DCM usually get to Ⅲ- Ⅳ level,which are accompanied by a variety of arrhythmia and enlarged heart. The 2 and 5 years survival are improved compared to the past, and the heart failure and sudden death is still the leading cause of death. 3% DCM belongs to familial DCM,which onset is similar with sporadic cases,but with poor prognosis.