儿童心肌病230例临床特点及预后影响因素分析

Clinical features of cardiomyopathy in 230 childrenand influence factors of prognosis

目的分析儿童心肌病的临床特点及预后影响因素。方法回顾性收集2011-2018年河南省儿童医院收治的230例0~14周岁心肌病病儿的临床资料,包括确诊时的一般资料,病情诊断与评估资料及预后资料,并进行统计分析。结果 230例病儿心肌病类型以扩张型心肌病(DCM)所占比重最高,其次为肥厚型心肌病(HCM)、心肌致密化不全(LVNC)、心动过速性心肌病(TIC),其他继发性心肌病所占比重较低。发病年龄以<5岁为主(占86.5%),且2015-2018年病例数占比高于2011-2014年。各类心肌病病儿中重度心衰或NYHA心功能Ⅲ~Ⅳ级者占比均超过50%,首次诊断时均以呼吸道症状为主,其次为消化道症状,DCM、HCM病儿肺部体征、肝脏肿大体征较为突出,其他继发性心肌病病儿多可见心血管症状。本组病儿死亡率为14.78%,多因素logistic回归分析显示中重度心衰或心功能Ⅲ~Ⅳ级、ST-T改变、异常Q波、左心室舒张末期内径(LVDD)、左心室后壁厚度(LVPW)、左室射血分数(LVEF)、血清N-末端脑钠肽前体(NT-Pro-BNP)、肌酸激酶同工酶(CK-MB)、肌钙蛋白(CTn)T均为病儿死亡相关的危险因素(P<0.05)。结论儿童心肌病类型多种多样,以DCM、HCM最为常见,好发年龄为5岁以内,多伴有较严重的心衰,以呼吸道、消化道症状为主,超声心动图指标(LVDD、LVPW、LVEF)、ST-T改变、异常Q波及血清指标(NT-Pro-BNP、CK-MB、CTnT)异常均为病儿预后的影响因素。

Objective To analyze the clinical features of cardiomyopathy and influence factors of prognosis.Methods The clinical data,including general data at the time of diagnosis,diagnosis of the condition,evaluation data and prognostic data of 230 children with cardiomyopathy who were 0-14 years old and admitted to Henan Children’s Hospital during the period from 2011 to 2018 were retrospectively collected.Statistical analysis was performed.Results In the 230 children with cardiomyopathy,the proportion of dilated cardiomyopathy(DCM)was the highest,followed by hypertrophic cardiomyopathy(HCM),left ventricular noncompaction(LVNC)and tachycardia-induced cardiomyopathy(TIC).The proportions of othersecondary cardiomyopathy were relatively lower.Themain onset age was smaller than 5 years old(86.5%).The proportion of casesbetween 2015 and 2018 was higher than that between 2011 and 2014.In children with various types of cardiomyopathy,the proportions of children with severe heart failure orNYHA grade III-IV cardiac function were higher than 50%.The respiratory symptom was the main symptom at initial diagnosis,followed by gastrointestinal symptoms.Thepulmonary signs and hepatomegaly signs of children with DCM and HCM were more obvious.There were cardiovascular symptoms inchildren with secondary cardiomyopathy.The mortality rate in this study was 14.78%.Multivariate logistic regression analysis showedthatmoderate to severe heart failure or grade III-IV cardiac function,ST-T changes,abnormal Q wave,left ventricular end diastolic diameter(LVDD),left ventricular posterior wall(LVPW)thickness,left ventricular ejection fraction(LVEF),serum N-terminal pro-brain natriuretic peptide(NT-Pro-BNP),creatine kinase isoenzyme(CK-MB)and troponin(CTn)T were risk factors for death of children(P<0.05).Conclusion There are many types of cardiomyopathy in children,and DCM and HCM are the most common.It easily occurs in children younger than 5 years old and most of them arecomplicated with severe heart failure,with respiratory tract and gastrointestinal symptoms as the main symptoms. Echocardiographic indexes(LVDD,LVPW,LVEF),ST-T changes,abnormal Q waves and abnormal serum indexes(NT-Pro-BNP,CK-MB,CTnT)are influence factors of prognosis.