老年人原发性扩张性心肌病(IDCM)

DIAGNOSIS AND RISK FACTORS OF IDIOPATHIC DILATED CARDIOMYOPATHY IN THE ELDERLY

目的探讨老年人 IDCM的诊断、病因或危险因素。方法对 43例年龄≥ 60岁原因不明的心脏扩大伴有弥漫性收缩减弱， EF< 40～ 45％的临床资料进行分析。结果 43例老年人 IDCM占同期 IDCM病人的 16.9％，男 36例，女 7例，平均年龄 67.5± 6.7(60～ 83)岁。易患因素包括高血压 (37.6％ )、吸烟 (51.2％ )、嗜酒 (27.5％ )、糖尿病 (16.3％ )、病毒感染 (6.9％ )、心肌病家族史 (6.9％ )、慢性呼吸道疾病 (4.7％ )。 43例中， 9例 (20.9％ )心电图左室肥大及劳损，其中 5例 (55.6％ )血压正常、 4例 (44.4％）并有高血压。 8例 (18.6％ )示有心电图异常 Q波及例置 T波、 UCG左室壁节段性活动异常以及心肌放射性分布局部缺损，其冠脉造影 6例正常， 2例前降支狭窄 < 50％。结论本症胸部 X片和心电图缺乏特异性， UCG和放射性核素影像对诊断 IDCM具有重要价值，选择性冠脉造影可正确地鉴别老年人 IDCM与 ISCM。本文病例中出现的易患因素或许可提供处于 IDCM多危险因素中的老年人的早期认识和防治。

Objective This study is aimed to diagnose the IDCM and to analyse the risk factors related to IDCM in the elderly. Methods The clinical data of 43 patients with IDCM aged≥ 60 years were studied. The diagnosis of IDCM was made by the evidence of ventricular dilatation and hypokinesis with EF< 40～ 45％ and the exclusions of secondary cardiomyopathy known. Results 43 cases of IDCM in the elderly accounted for 16.9％ of total IDCM during the same period; 36 males, 7 females, mean age 67.5± 6.7(60～ 83) years. The risk factors, that might be associated with IDCM in the elderly included hypertension (37.6％ ), smoking (51.2％ ), alcohol abuse (27.9％ ),diabetes mellitus (16.3％ ),viral infection (6.9％ ),family history of cardiomyopathy (6.9％ ) and chronic respiratory disease (4.7％ ). 9(20.9％ ) cases showed LVH with strain in ECG, in which 5(55.6％ ) had normotension and 4(44.4％ ) hypertension. 8(18.6％ ) cases who had one or more of the following situations: abnormal Q and/or inverted T waves in ECG, abnormal wall motion of the LV in UCG and local myocardial perfusion defect of the ventriculus in RNI, had presented with normal coronary arteries in 6 cases and LAD narrowing of < 50％ in 2 cases at the coronary angiography. Conclusions In diagnosis of IDCM the chest X－ ray film and ECG are lack of specificity, but the UCG and the RNI act an important role. Selective coronary angiography accurately distinguishes between patient with ISCM and patient with IDCM. The pattern of risk factors occurred in this analysis may allow for early identification, prevention and therapy of eledrly persons who are at increased risk of IDCM.