中国Takotsubo综合征病例的汇总分析

Clinical features of Chinese patients with Takotsubo syndrome

目的探讨中国Takotsubo综合征(TTS)患者的临床特征和诊治现状。方法该研究为病例汇总分析。在万方数据、中国知网、华艺台湾学术文献数据库、维普科技期刊中文数据库,以“Tako-tsubo”“Takotsubo”“Tako-tsubo心肌病”“Takotsubo心肌病”“Tako-tsubo综合征”“Takotsubo综合征”“Tako-tsubo样心肌病”“Takotsubo样心肌病”“Tako-tsubo cardiomyopathy”“Takotsubo cardiomyopathy”“应激性心肌病”“心尖部气球综合征”“心尖气球综合征”“心尖部气球样变”“心尖气球样”“心尖球形综合征”“心尖球囊样综合征”“心尖球囊样综合症”“心尖球形”为关键词,检索2007至2018年中国学者发表的TTS病例。采用2018年《TTS国际专家共识》中的诊断标准纳入病例,并排除资料不全或诊断存疑的病例。对起病时心电图呈非ST段抬高的TTS患者进行InterTAK诊断评分。根据2016年欧洲心脏病学会TTS专家共识的危险分层将纳入病例分为低危组和高危组,对两组患者进行分析和比较。结果研究纳入131篇文献中的160例TTS患者,纳入患者年龄(58.3±14.7)岁,其中女性137例(85.6%),年龄(59.6±14.0)岁。应激诱发因素包括情感应激和躯体应激124例(77.5%),其中情感压力因素83例(66.9%)。胸痛97例(60.6%),晕厥15例(9.4%),心力衰竭合并心原性休克48例(30.0%)。肌酸激酶同工酶和心肌肌钙蛋白T/I升高109例(80.1%)。心电图ST段抬高124例(77.5%)。有超声心动图记录者128例(80.0%),其中左心室射血分数<50%78例(73.6%)。有冠状动脉造影记录者133例(83.1%),其中冠状动脉正常或单支无意义狭窄126例(94.7%)。纳入患者中典型心尖型138例(87.3%)。纳入患者入院时的误诊率为96.9%(155/160),其中误诊为急性心肌梗死141例(88.1%)。药物治疗方面,应用硝酸甘油治疗36例(30.3%),血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体阻滞剂38例(31.9%),β受体阻滞剂46例(38.7%),多巴胺22例(18.5%),去甲肾上腺素12例(10.1%)。行主动脉内球囊反搏术(IABP)5例(3.1%),心肺复苏术9例(5.6%)。纳入患者心功能恢复时间为7(6,15)d。InterTAK诊断评分为(51.5±18.1)分,其中>70分2例(1.3%)。高危组患者共92例,其中有3例(3.3%)复发。纳入患者中有5例死亡。结论中国TTS患者以女性为主,发病年龄较轻,重症者较为多见,早期误诊率极高,临床上以药物治疗为主。

Objective To analyze the characteristics,diagnosis and treatment status of Takotsubo syndrome(TTS)of Chinese patients.Methods Complete literature review was performed to summarize Chinese TTS cases between 2007 and 2018.Results A total of 131 literatures were included including 160 TTS patients(age(58.3±14.7)years).There were 137 female patients(85.6%)in this cohort,the age was(59.6±14.0)years.There were 124 cases(77.5%)of stress-evoking factors,of which 83 cases(66.9%)were self-stress factors.There were 97 cases(60.6%)complained of chest pain and 15 cases(9.4%)with syncope.Forty-eight cases(30.0%)presented with cardiogenic shock.CK-MB and cTnT/I increased in 109 cases(80.1%).There were 124 cases(77.5%)presented with ST segment elevation on electrocardiogram,which were common in lead V2-V5.Echocardiography results were available in 128 cases(80.0%),reduced left ventricular ejection fraction(<50%)was reported in 78 cases(73.6%).Coronary angiography was performed in 133 patients(83.1%),of which 126 patients(94.7%)had normal coronary arteries or single non-significant stenosis.One hundred and thirty-eight patients(87.3%)were apical type.The misdiagnosis rate on admission was 96.9%(155/160),of which 141 cases(88.1%)were misdiagnosed as acute myocardial infarction.Nitroglycerin was used in 36 patients(30.3%).Angiotensin converting enzyme inhibitor or angiotensinⅡreceptor antagonist were used in 38 patients(31.9%).βblockers were used in 46 patients(38.7%).Dopamine was used in 22 cases(18.5%)and norepinephrine was used in 12 cases(10.1%).Intra-aortic balloon counter pulsation was used in 5 cases(3.1%).Cardiopulmonary resuscitation was performed in 9 cases(5.6%).Cardiac function recovery time was 7(6,15)days.The average InterTAK diagnosis score was(51.5±18.1)points,and value was>70 points in 2 cases(1.3%).There were 92 patients in the high-risk group,and there were 3 recurrent TTS cases.Five patients died.Conclusions TTS incidence tends to be young and dominates in female in China.The misdiagnosis rate is extremely high on admission.Most patients are treated with medication.