小儿扩张型心肌病预后影响因素

FACTORS THAT INFLUENCE THE PROGNOSIS OF DILATED CARDIOMYOPATHY IN CHILDREN

目的探讨小儿扩张型心肌病(DCM)预后的影响因素。方法回顾性分析20例DCM病儿的临床资料。结果首次入院时存在心力衰竭者18例(90%),心律失常16例(80%),心源性休克4例(20%)。死亡组(9例)病儿的左心室舒张末期内径(LVDd)及收缩末期内径(LVDs)均大于存活组(11例),左心室射血分数(LVEF)及左心室短轴缩短率(LVFS)均小于存活组,差异均有显著意义(t=2.13～3.25,P<0.05)。死亡组7例存在严重心律失常,存活组仅2例(P=0.028)。Logistic回归单因素分析提示,LVDd、LVDs、LVFS、LVEF及心律失常与预后有关(P=0.014～0.048);多因素分析显示,LVEF是预后的独立预测因素(P=0.018)。结论严重心律失常、低LVEF及LVFS、高LVDd及LVDs提示DCM病儿预后不良,提高LVEF可改善预后。

Objective To study the factors affecting prognosis of dilated cardiomyopathy （DCM） in children. Methods Clinical data of 20 children with DCM were retrospectively reviewed. Results Of the 20 sick children reviewed, 18 （90%） with heart failure at the first admission, 16 （80 %） with arrhythmias, and four （20%） with cardiogenic shock. In death group （9 pa- tients）, their left ventricular end diastolic inner diameter （LVDd） and left ventricular end systolic inner diameters （LVDs） were greater than that in survival group （n= 11）, and their left ventricular ejection fraction （LVEF） and left ventricular fractional short ening （LVFS） were lower （t=2.37-3.25,P〈0.05）. In the death group, seven had serious cardiacarrhythmias, there wereonly two in survival group （P=0. 028）. The logistic regression analysis revealed that the related factors with prognosis were LVDd, I.VDs, LVFS, LVEF and arrhythmias （P= 0. 014-0. 048）, and multivariate regression analysis indicated that LVEF was an inde- pendent factor related to the prognosis （P=0. 018）. Conclusion The presence of severe arrhythmia, low LVEF, LVFS, high LVDd and I.VDs were the predictors for a poor prognosis in children with DCM, raising LVEF can improve their prognosis.