18例非缺血性心肌病临床诊疗体会

Treatment of non-ischemic cardiomyopathy in 18 patients

目的：研究非缺血性心肌病（NICM）患者血清学指标、辅助检查指标与患者不良终点发生的关系。方法纳入2004年1月~2011年10月南京医科大学第二附属医院NICM患者18例，其中4例患者院内死亡，进入死亡组，其余14例患者进入存活组。采用酶联免疫吸附测定（ELISA）法对脑钠肽（BNP）、心脏肌动蛋白（cTnI）、肌红蛋白（MYO）进行检测，同时对两组患者住院期间NYHA心功能分级、心率（HR）、平均动脉压（MAP）、左心射血分数（LVEF）、心胸比等指标进行比较。结果与存活组相比，死亡组住院期间MBP明显较低[（78±15）mmHg vs.（87±15）mmHg，P＜0.05]，LVEF值下降[（28.3±7.2）%vs.（32.2±7.4）%，P＜0.05]，血清BNP明显升高[（2231±556）pg/ml vs.（647±231）pg/ml，P＜0.05]。结论非缺血性心肌病患者血清BNP升高、LVEF值明显下降以及cTnI轻微升高可提示患者不良事件高发风险。

Objective To study the relationship among serum biomarkers, accessory examination indexes and adverse events in the patients with non-ischemic cardiomyopathy （NICM）. Methods The NICM patients （n=18） were chosen from the Second Affiliated Hospital of Nanjing Medical University from Jan. 2004 to Oct. 2011, and among them 4 died in hospital （death group） and other 14 survived （survival group）. The levels of type B natriuretic peptide （BNP）, cardiac actin （cTnI） and myoglobin （MYO） were detected by using ELISA. Meanwhile the indexes of NYHA grading, heart rate （HR）, mean arterial pressure （MAP）, LVEF and cardiothoracic ratio （CTR） were compared between two groups during hospitalization. Results Compared with survival group, MAP was significantly lower, [（78 ±15） mmHg vs. （87±15） mmHg, P〈0.05], LVEF decreased [（28.3±7.2）%vs. （32.2±7.4）%, P〈0.05] and BNP increased significantly [（2231±556） pg/ml vs. （647±231） pg/ml, P〈0.05]. Conclusion Increased BNP, significantly decreased LVEF and slightly increased cTnI can indicate the higher risk of adverse events in NICM patients.