围生期心肌病临床及预后转归分析

Analysis of clinical characteristic and prognosis in patients with peripartum cardiomyopathy

目的探讨围生期心肌病（PPCM）的临床特征及影响预后转归的因素。方法选取2005年1月至2013年12月在首都医科大学附属北京安贞医院产科及心内科住院的18例PPCM患者临床资料，随访1年，按心功能是否改善分为病情改善组（7例）与病情持续组（11例）。记录患者临床资料，包括年龄、妊娠及生产史、并发症、感染史、发病孕周、症状、体征、治疗、分娩方式及孕周、心功能分级、超声心动图及心电图检查、血生化检查及脑钠肽检测结果。比较2组患者临床特征，分析影响患者预后转归的因素。结果18例PPCM患者随访1年后7例病情改善，11例病情持续，无患者死亡。病情改善组平均年龄（32．1±2．7）岁，经产妇5例，单胎6例，合并妊娠期高血压1例，首发心力衰竭时间为分娩前5例，分娩后2例，心功能分级Ⅱ级5例，Ⅲ级2例，Ⅳ级0例；病情持续组平均年龄（33．2±2．5）岁，经产妇9例，单胎10例，合并妊娠期高血压2例，首发心力衰竭时间为分娩前7例，分娩后4例，心功能分级Ⅱ级5例，Ⅲ级3例，Ⅳ级3例，2组患者年龄、经产妇例数、单胎例数、合并妊娠期高血压例数、首发心力衰竭时间及心功能分级比较，差异无统计学意义（均P〉0．05）。与病情持续组比较，病情改善组患者确诊时左心室舒张末期内径（LVEDD）较小[（58．1±1．9）mm比（60．2±1．5）mm]，左心室射血分数（LVEF）较高[（38．7±2．1）％比（33．1±4．6）％]，差异有统计学意义（均P〈0．05）。结论PPCM的临床表现主要为发生于产前或产后的心功能衰竭，确诊时LVEDD和LVEF可能为影响患者预后转归的因素。

Objective To study the clinical characteristics and prognosis in patients with peripartum cardiomyopathy （PPCM）. Methods The clinical data of 18 patients with PPCM in Beijing Anzhen Hospital from January 2005 to December 2013 were collected and followed up for one year. According to the ventficular function, the patients were divided into improved left ventricular dysfunction group （7 cases） and persistent left ventficular dysfunction group （11 eases）. The clinical data including age, pregnancy and delivery history, complications, infection history, disease time, symptoms, signs, treatment methods, delively mode and gestational weeks, cardiac function grade, results of echocardiogram and electrocardiogram, biochemical result and brain natIiuretie peptide level were recorded and compared between the two groups. Univariate regression was used to analyze the related factors for PPCM outcomes. Results Of the 18 patients, the cardiac function was improved in 7 cases; it was persistent in 11 cases and nobody died at one year follow-up. In left ventricular dysfunction improvement group, the age was （32.1 ±2.7） ; there were 5 multipara, 6 with single birth and 1 complicated with gestational hypertension;the heart failure occurred before delivery in 5 and after delivery in 2; there were 5 with cardiac function grade of Ⅱ, 2 with Ⅲ, 0 with Ⅳ. In persistent left ventricular dysfunction group, the age was （33.2 ±2.5） ; there were 9 multipara, 10 with single birth and 2 complicated with gestational hypertension; the heart failure occurred before delivery in 7 and after delivery in 4, there were 5 with cardiac function grade of Ⅱ, 3 with Ⅲ, 3 with Ⅳ. There were no significant differences in age, muhipara, gestational hypertension, attack time of heart failure and cardiac function grade （P 〉 0. 05）. Compared with those in persistent left ventricular dysfunction group, the diastolic diameters of left ventricular （LVEDD） in improved left ventricular dysfunction group was lower [ （58.1 ± 1.9） mm vs （60.2 ±1.5 ） mm ] and the left ventricular ejection fraction （LVEF） was higher [ （38.7 ±2. 1 ） % vs （33.1 ±4. 6 ） % ] at the time of diagnosis （ P 〈 0. 05 ）. Conclusions PPCM patients with persistent left ventricular dysfunction are likely to have large LVEDD and low LVEF at baseline which may be the influence factors for prognosis.