扩张型心肌病临床与预后的关系探讨

Discussion on the Relationship between Clinic and Prognosis of Primary Dilated Cardiomyopathy

目的 :探讨扩张型心肌病(DCM )发生心脏性猝死 (SCD)的高危因素 ,研究DCM临床与预后的关系。方法 :对 60例DCM临床资料进行分析 ,以超声心动图 (UCG)、心电图 (ECG)、动态心电图 (DCG、Holter)及X线胸片观察心脏各参数变化 ,并做心电图QT离散度 (QTd)测定。结果 :有病毒性心肌炎病史与无病毒性心肌炎病史病人 ,重度心力衰竭、严重室性心律失常的发生率分别为 66.7%和 2 3 .3 % ,经比较有统计学意义 (P <0 .0 5 ) ;5例SCD均有病毒性心肌炎史 ,临死前都发生多次严重室性心律失常、晕厥 ;QTd对预测SCD高危因素有意义。结论 :有病毒性心肌炎史、心力衰竭、严重室性心律失常、头晕或晕厥及QTd增加 ,可作为预测发生SCD的高危因素。

Objective:To inverstigate high risk factors of sudden cardiac death(SCD) in primary dilated cardiomyopathy(DCM), to research the relationship between cminic and prognosis of DCM. Methods:60 cases of DCM in our hospital were analysed and classified. The cardiac morphologic and functional parameters were examined with UCG. The heart-thorax ratios were measured by chest x-ray. The changes of heart rate and cardiac arrhythmias were monitored with Holter. QTd were determined by ECG. Results:The incidence of heavy failure and serious ventricular arrhythmia in patients with virus myocarditis(VM) history was higher than in patients without VM history (P<0.05). Syncopes and serious ventricular arrhythmias were showed in patients with VM history before death. QTd was an important index to predict prognosis. Conclusion:VM history, heart failure, serious ventricular arrhythmia and QTd increase are high risk factors of SCD in primary DCM.