儿童扩张型心肌病合并症临床分析

Comorbidities of Dilated Cardiomyopathy in Children

目的探讨儿童扩张型心肌病（DCM）合并症的临床特征。方法回顾性分析2010年3月-2014年12月我院儿科收治的60例DCM患儿的临床资料，分析儿童DCM的临床特征、实验室检查、合并症等。结果5岁以下儿童的患病率显著高于5岁以上的儿童（P〈0．05）；〈3岁的患儿，女性的比例显著高于男性；而3-5岁患儿中男性的比例高于女性（P〈0．05）；心功能Ⅳ级的患儿LVEF、LVES低于Ⅲ级和I～Ⅱ级，Ⅳ级患儿心率高于Ⅲ级和I-Ⅱ级，差异具有统计学意义（P〈0．05）；心功能Ⅳ级的患儿血清MMP-9、BNP、CRP水平高于Ⅲ级和I～Ⅱ级，与I-Ⅱ级相比差异具有统计学意义（P〈0．05）；合并呼吸系统感染60例，循环系统疾病31例，消化系统疾病30例，泌尿系统疾病11例，神经系统疾病4例，血液系统疾病1例。结论5岁以下儿童的DCM患病率较高，随着心功能分级的增加，患儿LVEF、LVES水平降低，血清MMP-9、BNP、CRP水平升高，IL-1β、IL—10、IL-4降低。建议将血清因子、超声心动图参数作为预测病情的指标。

Objective To investigate clinical features of comorbidities of dilated cardiomyopathy in children. Methods Clinical features, laboratory examination and comorbidities of 60 children with dilated cardiomyopathy （DCM） enrolled from Mar. 2010 to Dec. 2014 were retrospectively analyzed. Results The morbidity of children under 5 years old was significantly higher than that over 5 years old （ P 〈 0. 05 ）. The proportion of female was significantly higher than that of male in children under 3 years old. The proportion of male was higher than that of female in children from 3 to 5 years （P 〈 0.05 ）. LVEF and LVES in children with cardiac function level 1V were lower than chil- dren with cardiac function level III and I - 11. Heart rate in children with cardiac function level IV was higher than children with cardiac function level m and I - lI （P 〈 0.05）. MMP - 9, BNP and CRP in children with cardiac function level 1V were higher than children with cardiac function level IiIand I - 11 （P 〈 0.05）. IL - Iβ,IL - 10 and IL- 4 levels decreased as cardiac function level increased with statistical significance between cardiac function level IV and level I - II （ P 〈 0.05 ）. 60 children combined with respiratory system infections,31 children combined with circulatory system diseases ,30 children combined with digestive system diseases, 11 children combined with uri- nary system diseases,4 children combined with nervous system diseases and 1 child combined with hematological dis- eases. Conclusion The morbidity of DCM in children under 5 years old is high. Levels of LVEF and LVES decrease, levels of serum MMP - 9, BNP and CRP increase, and levels of IL - 1β, IL - 10 and IL - 4 decrease with cardiac function classification increases. Serum factors and echocardiographic parameters are suggested as predictors of the disease.