扩张型心肌病中心室肌致密化不全的识别

Identification of noncompaction of ventricular myocardium in dilated cardiomyopathy

目的:探讨扩张型心肌病(DCM)中心室肌致密化不全(NVM)的识别及临床诊断。方法:收集2006-09-2010-09期间在我院初步诊断为DCM的住院患者共551例,根据患者病史、临床表现、辅助检查(彩色多普勒超声心动图、心电图、心脏磁共振等)、诊治过程以及随访结果等资料进行回顾性分析。结果:551例患者中,经超声心动图及心脏磁共振发现并确诊为NVM的患者34例,占DCM总数的6.17%,其检出率从2006年起呈逐年上升趋势。34例确诊为NVM的患者均表现有不同程度的心力衰竭;32例(94.12%)出现心电图异常;彩色超声心动图检测34例均可见NVM的典型改变(100%),其病变部位均累及左室;20例NVM患者平均随访(23±11)个月,4例死亡,主要死因为心力衰竭加重。结论:NVM患者以心力衰竭和心律失常为主要表现就诊,在DCM患者超声心动图检测时要注意识别DCM的病因之一———NVM,其检出率将会逐年上升。由于NVM预后不良,药物治疗只能缓解症状,心脏移植为终末阶段的治疗选择。

Objective：To investigate the identification and clinical diagnosis of noncompaction of ventricular myocardium（NVM） in dilated cardiomyopathy（DCM）. Method：A retrospective study of 551 patients hospitalized for DCM from September 2006 to September 2010 was performed in Union Hospital（Wuhan）.This retrospective analysis was carried out according to medical history of the patients,clinical manifestation,auxiliary examinations（including UCG,ECG,CMR and so on）,treatment processes and follow-up survey results. Result：In 551 patients,34 patients were found and confirmed as NVM through UCG or MRI,which accounted for 6.17% of total DCM patients,and it showed an increasing trend from 2006;In the 34 NVM patients,all patients showed varying degrees of heart failure;ECG showed abnormal change in 32 NVM patients（94.12%）;Typical changes of NVM were seen in all patients（100%） in UCG with lesions located in the left ventricle.In the follow-up of 20 cases of NVM patients for（23±11）month,4 patients dead,the main cause of death was the aggravation of heart failure. Conclusion：NVM patients often see a doctor for heart failure or arrhythmia.During UCG detection we should identify the NVM,one of DCM originations,and the detection rate of NVM will be elevated year by year.Because patients with NVM in DCM have poor prognosis,drug treatment can only improve symptoms,and heart transplantation will be the final treatment means.