围产期心肌病的临床特点及预后分析

The clinical characteristics and prognosis of patients with peripartum cardiomyopathy

目的研究围产期心肌病的临床特点及预后相关因素。方法回顾分析1995年1月至2014年12月间北京协和医院诊断为围产期心肌病的35例住院患者的临床资料及随访记录。根据发病6个月内左心室射血分数（LVEF）是否恢复正常（≥50％），将患者分为早期恢复和病情迁延两组。比较两组的基线资料，分析与病情迁延有关的危险因素。结果北京协和医院在上述时间段内围产期心肌病发生率为每1067次分娩1例产妇发病。35例患者年龄（28．9±5．6）岁，其中20例（57．1％）妊娠大于1次，13例（37．1％）为经产妇，5例（14．3％）为双胎妊娠，明确诊断时LVEF为（34．1±8．0）％。22例（62．9％）患者早期恢复，其他13例（37．1％）发病6个月后LVEF仍持续减低，其中2例死亡。Logistic回归分析提示LVEF（DR1．339，95％C11．063—1．688，P=0．013）以及左心室舒张末内径（OR0．763，95％C10．607～0．960，P=0．021）是病情迁延的独立危险因素。结论围产期心肌病是较为少见的产科并发症，诊断时LVEF以及左心室舒张末内径是影响疾病转归的独立危险因素。

Objective To explore the peripartum cardiomyopathy （PPCM）. Methods clinical characteristics and risk factors in patients with A total of 35 patients admitted in Peking Union Medical College Hospital and diagnosed with PPCM between January 1995 and December 2014 was included and analyzed in this study. The subjects were divided into two groups： the early recovery and delayed recovery. Early recovery was defined as normalization of left ventricle ejection fraction （LVEF） ≥ 50% before 6 months post-diagnosis. Delayed recovery was defined if the length of time required for recovery of LVEF was longer than 6 months or death was reported during follow-up. Risk factors for delayed recovery were assessed. Results The incidence of PPCM was 1 per 1 067 deliveries between the study periods. The age of the 35 patients was （28.9 ± 5. 6） years old. Among them, 20 （57. 1% ） patients were not in the first pregnancy, 13 （37.1%） had delivered before, and 5 （14.3%） patients had twin pregnancies. The LVEF at diagnosis was （34. 1 ±8.0） %. 62.9% （22 cases） of the subjects were in the early recovery, while 37. 1% （13 cases） of the subjects were in the delayed recovery group, 2 of whom suffered death. Multivariate logistic regression indicated that LVEF （ OR = 1.339, 95% CI 1.063 - 1.688, P = 0. 013 ） and left ventricle end-dilated diameter （ OR O. 763, 95% CI 0. 607 - 0. 960, P = 0. 021 ） were independent risk factors for delayed recovery. Conclusions PPCM is a rare but life-threatening complication of pregnancy. LVEF and left ventricle end-dilated diameter at diagnosis were two independent factors associated with the prognosis of PPCM.