原发性扩张型心肌病和酒精型心肌病患者临床与预后对比研究

Comparison of clinical characteristics and prognostic analysis between idiopathic dilated cardiomyopathy and alcoholic cardiomyopathy

目的:比较原发性扩张型心肌病(IDCM)和酒精型心肌病(ACM)患者的临床特点和预后。方法:回顾性分析464例患者的临床资料,其中IDCM患者165例(IDCM组),ACM患者299例(ACM组);分别对2组患者进行生存分析。结果:ACM组患者初次发病年龄较IDCM组低,且左室舒张末期内径(LVEDd)、右室内径(RV)、左房内径(LA)以及心功能分级Ⅲ、Ⅳ级的患者比例均大于IDCM组,此外,2组患者在性别、吸烟史、肌酐(Cr)、尿素氮(BUN)、氨基末端B型脑钠肽前体(NT-proBNP)水平、QRS波宽均存在显著差异(P<0.05),但两组总生存率比较差异无统计学意义(log rankχ~2<0.001,P=0.994);单因素Cox回归分析结果表明:在IDCM组中,年龄、心功能分级、舒张压(DBP)、完全性右束支传导阻滞(CRBBB)、LVEDd、右房内径(RA)是IDCM的预后指标;在ACM组中,心功能分级、收缩压(SBP)、QRS波宽、心房颤动、LVEDd、RV、RA、左室射血分数(LVEF)、NT-proBNP水平是ACM的预后指标。多因素Cox回归分析结果表明:LVEDd(HR=1.034,95%CI:1.004～1.066,P=0.029)和CRBBB(HR=2.898,95%CI:1.201～6.995,P=0.018)为IDCM患者全因死亡的独立预测指标;心功能分级(HR=1.595,95%CI:1.110～2.290,P=0.011)、SBP(HR=0.980,95%CI:0.963～0.997,P=0.020)和QRS波宽(HR=1.014,95%CI:1.004～1.019,P=0.003)为ACM患者全因死亡的独立预测指标。结论:ACM的临床症状更明显,心脏扩大更显著;IDCM和ACM的长期预后相近,但独立预后因素不一致。

Objective： To compare the clinical characteristics and prognostic between idiopathic dilated cardiomyopathy （IDCM） and alcoholic cardiomyopathy （ACM）. Method：Clinical data of 464 patients （IDCM 164 and ACM 299） admitted to our hospital were retrospectively analyzed. Risk factors of the survival in 2 group of patients were analyzed with survival analysis, respectively. Result ： Patients with ACM had lower average age of first onset. Left ventricle end diastolic diameter（LVEDd） right ventricle, left atrium diameter in patients with ACM were higher than those in the IDCM group. There were greater frequencies of high New York Heart Association （NYHAⅢ/Ⅳ） classification in the ACM patients. Moreover, there were significant difference in sex composition, smoking history, QRS duration, and the circulating level of creatinine, urea nitrogen and N terminal probrain natriuretic peptide （NT-proBNP） in 2 groups （P〈0.05）. Kaplan-Meier survival curve analysis indicated that there was no difference in mortality between IDCM and ACM patients （log rank χ^22 〈0. 001, P=0. 994）. The univariate analysis indicated that age, NYHA, diastolic blood pressure, right bundle branch block （CRBBB）, LVEDd and right atrium diameter were predictors in IDCM patients. In ACM patients, NYHA, diseases duration, systolic blood pressure （SBP）, diastolic blood pressure, QRS duration, atrial fibrillation, LVEDd, right ventricle diameter, left atrium diameter,left ventricular ejection fraction, and NT-proBNP were predictors in ACM patients. Independent predictors of all-cause mortality in the multiple Cox regression analysis were and LV （HR 1. 034,95%CI：1. 004-1. 066,P=0. 029） and CRBBB（HR=2. 898,95%CI：1. 201~6. 995,P=0. 018） at admission in IDCM patients. In ACM patients, independent predictors of all-cause mortality in the multiple Cox regression analy sis were NYHA （HR=1. 595,95%CI：1. 110~2. 290,P=0. 011）, SBP（HR=0. 980,95%CI：0. 963~ 0. 997,P=0. 020） and QRS duration（HR= 1. 014,95%CI： 1. 004~1. 019,P=0. 003） at admission. Conclusion.. The cardiac dilatation and clinical symptoms in ACM were much more serious than IDCM, but there was on difference in the long-term prognosis of IDCM and ACM patients and their predictors were distinctive.