2019 年第 11 期 第 14 卷

围产期心肌病患者预后的相关因素及急性肾损伤对预后的影响

Prognostic factors of peripartum cardiomyopathy and the influence of acute kidney injury on prognosis

作者：朱佳佳刘文娴

英文作者：

单位：100029首都医科大学附属北京安贞医院心内科监护室北京市心肺血管疾病研究所

英文单位：

关键词：围产期心肌病；急性肾损伤；左心室射血分数

英文关键词：

• 摘要：

• 【摘要】目的    探讨围产期心肌病（PPCM）患者预后无改善的相关因素及急性肾损伤（AKI）对预后的影响。方法    选择2007年1月至2018年6月首都医科大学附属北京安贞医院诊治的PPCM患者60例，根据患者的预后分为预后改善组（32例）和预后无改善组（28例）。比较2组患者的一般情况、超声心动图、心电图、实验室检查和治疗情况，分析预后无改善的相关因素及AKI对预后的影响。结果    预后无改善组患者经产妇、纽约心脏病协会心功能Ⅲ~Ⅳ级、AKI比例高于预后改善组［78.6%(22/28)比43.8%（14/32）、92.9%(26/28)比71.9%（23/32）、35.7%(10/28)比3.1%（1/32）］，平均年龄以及入院血肌酐、B型脑钠肽水平高于预后改善组［(32±6)岁比（29±4）岁、66(57,83)μmol/L比54(44,65)μmol/L、1 436(696,2 353)ng/L比356(67,819)ng/L］,地高辛使用比例高于预后改善组［75.0%(21/28)比28.1%（9/32）］，左心室舒张末期内径大于预后改善组［(53±8)mm比（43±8）mm］，左心室射血分数、收缩压低于预后改善组［(30±10)%比（43±12）%、(111±17)mmHg（1 mmHg=0.133 kPa）比（122±16）mmHg］,差异均有统计学意义（均P＜0.05）。Logistic回归分析结果显示，AKI(比值比=10.556,95%置信区间:1.177~94.654,P=0.035)及左心室射血分数＜40%(比值比=4.533,95%置信区间:1.118~18.382,P=0.034)为PPCM预后无改善的危险因素。结论    住院期间发生AKI的PPCM患者预后较差，临床应引起注意。

• 【Abstract】Objective    To explore the risk factors of poor prognosis in patients with peripartum cardiomyopathy(PPCM) and the influence of acute kidney injury (AKI) on prognosis. Methods    A total of 60 patients with PPCM admitted to Beijing Anzhen Hospital, Capital Medical University from January 2007 to June 2018 were divided into good response group(32 cases) and poor prognosis group(28 cases). General clinical data, echocardiogram and electrocardiogram findings, laboratory examination results and treatment regimens were recorded. Risk factors of poor prognosis and the influence of AKI on prognosis were analyzed. Results    Compared with the good response group, the poor prognosis group had more multiparae［78.6%(22/28) vs 43.8%(14/32)］ and NYHA heart function grade Ⅲ-Ⅳ［92.9%(26/28) vs 71.9%(23/32)］, higher incidence of AKI［35.7%(10/28) vs 3.1%(1/32)］, age［(32±6)years vs （29±4）years］, serum creatinine level at admission［66(57,83)μmol/L vs 54(44,65)μmol/L］, B-type natriuretic peptide level at admission［1436(696,2 353)ng/L vs 356(67,819)ng/L］, use rate of digoxin［75.0%(21/28) vs 28.1%(9/32)］ and left ventricular end-diastolic diameter［(53±8)mm vs (43±8)mm］, lower left ventricular ejection fraction［(30±10)% vs (43±12)%］ and systolic pressure［(111±17)mmHg vs (122±16)mmHg］, with statistically significant differences(all P<0.05). Logistic regression analysis showed that AKI(odds ratio=10.556, 95% confidence interval: 1.177-94.654, P=0.035) and left ventricular ejection fraction<40%(odds ratio=4.533, 95% confidence interval: 1.118-18.382, P=0.034) were risk factors of poor prognosis. Conclusion    PPCM patients suffering from AKI during hospitalization have poor prognosis.