围生期心肌病发病及院内预后影响因素分析

Analysis of risk factors for the occurrence and in-hospital prognosis in patients with peripartum cardiomyopathy

目的探讨围生期心肌病(PPCM)发病及院内预后不良的影响因素。方法回顾性分析2003年1月至2022年1月首都医科大学宣武医院和首都医科大学附属北京友谊医院35例PPCM患者和35例健康孕妇的临床资料。记录个人史、实验室检查、影像学检查、心功能转归等。根据出院时左心室射血分数(LVEF)将PPCM患者分为院内恢复组(LVEF≥50%,18例)和病情迁延组(LVEF<50%,17例)。采用多因素Logistic回归分析影响PPCM患者院内预后不良的独立危险因素。结果 35例PPCM患者年龄(29.81 ± 5.37)岁,合并妊娠期高血压疾病17例(48.57%),合并妊娠期糖尿病6例(17.14%),纽约心脏病协会(NYHA)心功能分级Ⅲ~Ⅳ级24例(68.57%),死亡4例(11.43%)。PPCM患者分娩孕周明显早于健康孕妇[(36.26 ± 4.27)周比(38.54 ± 4.59)周],多胎妊娠率和合并妊娠期高血压疾病率明显高于健康孕妇[17.14%(6/35)比2.86%(1/35)和48.57%(17/35)比11.43%(4/35)],差异有统计学意义(P<0.05或<0.01)。与院内恢复组比较,病情迁延组发病孕周更早,左心室舒张末期内径更大,血肌酐、C反应蛋白和氨基末端脑钠肽前体(NT-proBNP)更高,NYHA心功能分级更差,差异有统计学意义(P<0.05或<0.01);而两组初诊时LVEF和肌钙蛋白I比较差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,肌酐升高是影响PPCM患者院内预后不良的独立危险因素(OR = 4.554,95%CI 1.536~13.684,P = 0.018)。结论合并妊娠期高血压疾病可能为PPCM发病的危险因素。合并妊娠期高血压疾病、发病时间较早、左心室舒张末期内径扩大、高NT-proBNP、高C反应蛋白、高肌酐、NYHA心功能分级更高可能为PPCM患者院内预后不良的危险因素,而高肌酐为影响PPCM患者院内不良预后的独立危险因素。

Objective To investigate the risk factors for the occurrence and poor in-hospital prognosis in patients with peripartum cardiomyopathy(PPCM).Methods The clinical data of 35 patients with PPCM and 35 healthy pregnant women in Xuanwu Hospital,Capital Medical University and Beijing Friendship Hospital Affiliated to Capital Medical University from January 2003 to January 2022 were retrospectively analyzed.The personal histories,laboratory examination,imaging examination,cardiac function outcome,etc were collected.According to the left ventricular ejection fraction(LVEF)at discharge,the patients with PPCM were divided into in-hospital recovery group(LVEF≥50%,18 cases)and prolonged disease group(LVEF<50%,17 cases).Multivariate Logistic regression analysis was used to analyze independent risk factors of poor in-hospital prognosis in patients with PPCM.Results Among 35 patients with PPCM,the age was(29.81±5.37)years old,17 cases(48.57%)complicated with gestational hypertension,6 cases(17.14%)complicated with gestational diabetes mellitus,24 cases(68.57%)of New York Heart Association(NYHA)cardiac function classification wasⅢtoⅣclass,and 4 cases died(11.43%).The gestational age in patients with PPCM was significantly shorter than that in healthy pregnant women:(36.26±4.27)weeks vs.(38.54±4.59)weeks,the rates of multiple pregnancy and gestational hypertension were significantly higher than those in healthy pregnant women:17.14%(6/35)vs.2.86%(1/35)and 48.57%(17/35)vs.11.43%(4/35),and there were statistical differences(P<0.05 or<0.01).Compared with hospital recovery group,the patients in protracted disease group had shorter gestational age,larger left ventricular end-diastolic diameter,higher serum creatinine,C-reactive protein and amino-terminal pro-brain natriuretic peptide(NT-proBNP),worse NYHA cardiac function classification,and there were statistical differences(P<0.05 or<0.01);but there were no statistical difference in LVEF at the first diagnosis and troponin I between two groups(P>0.05).Multivariate Logistic regression analysis result showed that elevated creatinine was an independent risk factor for poor in-hospital prognosis in patients with PPCM(OR=4.554,95%CI 1.536 to 13.684,P=0.018).Conclusions The gestational hypertension may be a risk factor for PPCM.The gestational hypertension,earlier onset time,enlarged left ventricular end-diastolic diameter,high NT-proBNP,high C-reactive protein,high creatinine and high cardiac function NYHA classification may be risk factors for poor in-hospital prognosis in patients with PPCM;and elevated creatinine is an independent risk factor for poor in-hospital prognosis in patients with PPCM.