苏中地区老年应激性心肌病患者临床特点及预后评价

Clinical characteristics and prognosis of stress cardiomyopathy in Central Jiangsu Province

目的分析苏中地区应激性心肌病患者的临床发病特点及远期预后情况。方法收集2013年10月至2023年8月江苏省苏北人民医院住院确诊的老年应激性心肌病患者20例,均有明确应激诱因。收集临床资料,定期随访,记录疾病再发及死亡等不良事件发生情况。死亡2例,第3天要求转上级医院治疗1例,余17例患者出院前与入院时各血生化指标进行比较。结果应激性心肌病患者出院前心肌肌钙蛋白I、肌酸激酶同工酶、N末端B型钠尿肽前体、C反应蛋白、天冬氨酸转氨酶、丙氨酸转氨酶、碱性磷酸酶、三酰甘油、总胆固醇、低密度脂蛋白胆固醇、白细胞计数较入院时明显降低,高密度脂蛋白胆固醇、红细胞计数、血红蛋白较入院时明显升高,差异有统计学意义(P<0.05,P<0.01)。出院前复查超声心动图显示,左心房内径、左心室舒张末期内径、左心室收缩末期内径、左心室射血分数、左心室短轴缩短率与入院时比较,差异有统计学意义(P<0.05,P<0.01)。冠状动脉造影检查17例,17例平均随访(3.45±1.47)年,仅1例复发,16例病情好转。超声心动图复查室壁运动异常消失。结论应激性心肌病患者发病早期常有节段性室壁运动异常,伴心功能异常,积极治疗后复查室壁运动异常可消失,心功能可恢复,治疗上强调对症,注意随访,警惕复发。

Objective To analyze the clinical characteristics and long-term prognosis of patients with stress cardiomyopathy in Central Jiangsu Province.Methods Twenty stress cardiomyopathy patients with identified emotional/physical stress triggers admitted to Northern Jiangsu People's Hospital from October 2013 to August 2023 were enrolled in this study.All of them were followed up regularly after their clinical data were collected.Occurrence of recurrence,death and other adverse events were recorded.Two patients died,1 patient requested to be transferred to a superior hospital for treatment on the 3rd day.The blood biochemical indicators of the remaining 17 patients were compared before discharge and admission.Results The levels of cTnI,creatine kinase isoenzymes,N-terminal B-type natriuretic peptide precursor(NT-proBNP),C-reactive protein,aspartate aminotransferase,alanine aminotransferase,alkaline phosphatase,TG,TC and LDL-C,and WBC count were obviously decreased,while HDL-C and hemoglobin levels and RBC count were significantly increased in the stress cardiomyopathy patients before discharge when compared with corresponding levels at admission(P<0.05,P<0.01).Before discharge,echocardiography indicated significant decreases were observed in left atrial diameter,left ventricular end-diastolic diameter,left ventricular end-systolic diameter,LVEF,and left ventricular short axis shortening rate when compared with the values at admission(P<0.05,P<0.01).There were 17 cases undergoing coronary angiography.During the follow-up period for 3.45±1.47 years,only 1 case relapsed and the other 16 cases improved,and echocardiography displayed that the abnormal ventricular wall motion disappeared.Conclusion Segmental wall motion abnormalities are common in the early stage of stress cardiomyopathy,accompanied by abnormal heart function.After active treatment,abnormal wall motion can disappear and heart function can be restored.Therefore,clinicians should emphasize symptomatic treatment and pay attention to surveillance for recurrence during follow-up period.