围生期心肌病的临床特征和预后

Clinical Characteristics and Prognosis of Peripartum Cardiomyopathy in 28 Patients

目的总结围生期心肌病（PPCM）的临床特征及预后。方法回顾性分析北京协和医院1983年1月至2014年12月收治的病例资料较完整的28例PPCM患者的临床资料,随访至少6个月或至全因死亡及心脏移植。结果 28例患者均有不同程度的心功能不全表现,基线左心室射血分数（LVEF）平均为（36.2±11.8）%。21例患者进行了随访,中位随访时间27个月,16例（76%）LVEF改善;5例（24%）患者无改善,其中1例死亡。改善组和无改善组患者在基线LVEF（P=0.007）、基线左心室舒张末期内径（LVEDD）（P=0.040）、随访时LVEF（P〈0.001）和随访时LVEDD（P〈0.001）方面差异均有统计学意义。Cox回归分析结果显示,基线LVEF高（RR：0.89,95%CI：0.83-0.96,P=0.002）和LVEDD小（RR：0.90,95%CI：0.83-0.99,P=0.026）与PPCM患者LVEF改善相关。结论 PPCM经及时诊断和正规治疗,部分患者的心功能可明显改善,基线LVEF高或LVEDD小的患者左心室收缩功能恢复的可能性大。

Objective To analyze the clinical features and prognosis of patients with peripartum cardiomyopathy（ PPCM）. Methods The clinical data of 28 PPCM patients with PPCM diagnosed in Peking Union Medical College Hospital from January 1983 to December 2014 were retrospectively analyzed and followed up for at least 6 months or to death or cardiac transplantation. Results All patients were presented with heart failure.Mean baseline left ventricular ejection fraction（ LVEF） was（ 36. 2 ± 11. 8） %. After a median follow-up of 27 months,16 of the 21 patients（ 76%） showed improvement in LVEF and 5 patients（ 24%） did not have improvement in their LVEF. Only 1 patient died. There were significant differences between improved and non-improved patients in baseline LVEF（ P = 0. 007）,baseline left ventricular end-diastolic dismension（ LVEDD）（ P =0. 040）,follow-up LVEF（ P〈0. 001）,and follow-up LVEDD（ P〈0. 001）. Cox regression analysis showed that higher LVEF（ RR： 0. 89,95% CI： 0. 83-0. 96,P = 0. 002） and smaller LVEDD（ RR： 0. 90,95% CI：0. 83-0. 99,P = 0. 026） were predictors of improvement in LVEF. Conclusions Early diagnosis and regular treatment helps to improve the prognosis of PPCM. Patients with higher LVEF and smaller LVEDD appear to be the most likely to recover.