由癫痫引起Takotsubo心肌病的临床特点分析

Analysis in clinical features of patients with Takotsubo cardiomyopathy induced by seizure

目的由癫痫引起Takotsubo心肌病(TCIS)的报道日渐增加,但都是个案报道,本研究汇总所有TCIS的病例报道,并总结其临床特点。方法利用Pubmed文摘数据库、爱思唯尔、万方医学网、维普期刊资源整合平台等检索相关文献。筛选TCIS的病例报道,统计汇总各项临床资料,并与普通Takotsubo心肌病(TTC)的大样本研究做对照分析。结果共筛选出41例病例符合要求,女31例(73.7%,P=0.007),男10例(26.3%),总体平均年龄为(60.7±12.1)岁(P<0.05)。癫痫均为全面发作性,以全面强直阵挛性发作居多。28.2%的患者伴有胸痛和(或)呼吸困难(P<0.05)。在并发症中,心律失常占30.8%(P=0.97),肺水肿占28.2%(P<0.05),电解质紊乱占22.0%。心电图显示ST段抬高占55.0%(P<0.05),ST段压低占12.5%(P=0.001),T波倒置占50.0%(P=0.084)。超声心动图显示心尖、心室中部运动障碍各占81.6%(P=0.946)、39.5%(P=0.001),同时还涉及其他多部位运动功能的减弱,平均左室射血分数(LVEF)为33.8%±8.6%(P<0.05)。10.8%的患者冠状动脉存在显著狭窄。在心肌酶学检查中,肌钙蛋白升高占96.4%(P=0.293)、肌酸激酶升高占72.7%(P=0.331)、肌酸激酶同工酶升高占100%(P=0.290)。平均(27.2±11.1)d恢复(P<0.05),病死率为7.3%(P<0.05)。结论 TCIS与普通TTC相比,其发病人群年轻化,女性比重减少,胸痛不明显,可发生多种心肺并发症,以心律失常和肺水肿多见,心电图ST段抬高比例降低,ST段压低比例更高,超声心动图显示心脏运动障碍更严重。心肌酶学无显著差异。TCIS恢复时间更长,病死率更高,并与癫痫猝死相关相关,应引起足够重视。

Objective Takotsubo cardiomyopathy induced by seizure（ TCIS） was reported worldwide. However,it was always reported as individual case. The purpose of this study was to gather all the case reports of TCIS and to summarize the clinical features. Methods The case reports of TCIS were searched and picked out from the Pubmed,Elsevier,Wanfang and Weipu databases. The clinical statistics of TCIS patients from selected case reports were gathered and analyzed with the study of typical Takotsubo cardiomyopathy（ TTC） based on large sample. Results Totally 41 patients met the criteria,10 males and 31 females,accounted for 26. 3% and 73. 7%（ P = 0. 007） respectively.The mean age of all the patients was（ 60. 7 ± 12. 1） years（ P〈 0. 05）. The seizures were all generalized types,which generalized tonic-clonic seizure（ GTCS） was the most common type. Patients accompanied by chest pain and（ or） dyspnea took up 28. 2%（ P〈 0. 05）. All kinds of complications occurred during the development of this disease： arrhythmia（ 30. 8%,P = 0. 97）,pulmonary edema（ 28. 2%,P〈 0. 05） and electrolyte disturbances（ 22. 0%）. ST-segment elevation was reported in55. 0%（ P〈 0. 05） of all,ST-segment depression in 12. 5%（ P = 0. 001） and T wave inversion in50. 0%（ P = 0. 084）. Typically,systolic apical ballooning of left ventricular could be showed in the echocardiography in 81. 6%（ P = 0. 946） of all. Hypokinesis of mid-ventricular（ 39. 5%,P =0. 001） and many other portions could also be demonstrated. The mean left ventricular ejection fraction was only（ 33. 8 ± 8. 6） %（ P〈 0. 05）. Stenosis of coronary was found in 10. 8% of the patients. Elevation of serum cardiac troponin, creatine kinase and creatine kinase-MB occcupied96. 4%（ P = 0. 2 9 3）,7 2. 7 %（ P = 0. 3 3 1） and1 0 0 %（ P = 0. 2 9 0） respectively. The duration ofrecovery was（ 2 7. 2 ± 1 1. 1） days（ P〈 0. 0 5）. The case fatality rate was 7. 3 %（ P〈 0. 0 5）.Conclusion Compared with typical TTC,TCIS patients are younger. Complications related with heart and lung such as arrhythmia and pulmonary edema are the most frequent. The proportion of ST-segment elevation is reduced,and ST-segment depression is raised. The dysfunction of heart is severe in TCIS by the test of echocardiography. There is no significant difference in cardiac biomarkers between TCIS and TTC. Longer duration of recovery,higher case fatality and the close relationship of sudden unexpected death in epilepsy suggest us pay intensive attention to TCIS.