扩张型心肌病左心室逆重构复发的影响因素分析

Influencing Factors of Recurrence of Left Ventricular Reverse Remodeling in Dilated Cardiomyopathy

目的:探讨扩张型心肌病患者左心室逆重构复发的风险预测指标。方法:对2012年2月-2017年2月本院收治的200例扩张型心肌病左心室逆重构患者的临床资料进行回顾性分析,均随访2年,均明确随访期间是否复发。总结可能影响左心室逆重构复发的危险因素,对比复发者和未复发者上述可能危险因素的构成比差异,以logistic回归分析模型探讨其危险因素。结果:本组受试者中复发率为14.00%;复发者合并高血压、2型糖尿病、高脂血症、RDW>43.9%、伴有冠心病、心电图QRS间期<100 ms、基线LVEDD>正常的20%,基线LVEF<正常的20%者构成比均明显高于未复发者(P<0.05),且经logistic回归分析证实均为左心室逆重构复发的危险因素(OR=6.973、7.214、6.240、6.945、2.945、7.250、6.713、6.221,P<0.05);两者性别、年龄、手术治疗构成比对比,差异均无统计学意义(P>0.05);复发者ACEI类药物应用者构成比明显低于未复发者(P<0.05),且经logistic回归分析证实为保护因素(OR=0.422,P<0.05)。结论:扩张型心肌病左心室逆重构复发的风险高,其中合并高血压、2型糖尿病、高脂血症等均为其危险因素,ACEI类药物应用是其保护因素。

Objective:To explore the risk predictors of recurrence of left ventricular reverse remodeling in patients with dilated cardiomyopathy.Method:The clinical data of 200 patients with dilated cardiomyopathy with left ventricular retrograde remodeling admitted to our hospital from February 2012 to February 2017 were retrospectively analyzed.All patients were followed up for 2 years,and whether they recurred during the follow-up period was confirmed.The risk factors that may affect the recurrence of left ventricular reverse remodeling were summarized,and the proportions of the above risk factors between recurrence and non-recurrence were compared,then the risk factors by logistic regression analysis model were explored.Result:The recurrence rate was 14.00%.The rates of hypertension,type 2 diabetes mellitus,hyperlipidemia,RDW>43.9%,coronary heart disease,electrocardiogram QRS interval<100 ms,baseline LVEDD>20% of normal,baseline LVEF<20% of normal in the recurrence patients were significantly higher than those of non-recurrence(P<0.05).Logistic regression analysis confirmed that all of them were risk factors for recurrence of left ventricular reverse remodeling(OR=6.973,7.214,6.240,6.945,2.945,7.250,6.713,6.221,P<0.05).There were no significant differences in gender,age and compositions of surgical treatment between two groups(P>0.05).The proportion of ACEI drug application in relapsed patients was significantly lower than that in non-relapsed patients(P<0.05),and it was confirmed as a protective factor by logistic regression analysis(OR=0.422,P<0.05).Conclusion:Dilated cardiomyopathy has a high risk of recurrence of left ventricular reverse remodeling,including hypertension,type 2 diabetes mellitus,hyperlipidemia and so on,and ACEI drug application is a protective factor.