中国围生期心肌病临床特征及预后系统分析
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摘要
目的:通过对我国围生期心肌病(PPCM)公开发表研究进行归纳、整理和系统分析,明确我国PPCM临床现状。方法:对2018年11月前,在pubmed、万方数据库、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)中发表的关于PPCM的文献进行文献检索,选取符合条件的研究进行荟萃分析。结果:共检索到文献2 340篇,符合条件最终入选的351篇文献累计报告病例9 071例。PPCM患者平均年龄(28.24±8.50)岁,初产妇约占49.9%,经产妇占50.1%;资料显示有61.3%的患者在产后发病,38.7%产前发病。纳入分析的3 187例患者中,有38.6%患者合并贫血,17.4%合并感染,30.2%合并高血压,4.6%合并营养不良。84.2%的患者有不同程度的左心增大,EF值平均为(36.24±7.10)%。PPCM患者平均住院日(19.23±12.11)d。有转归资料可纳入分析的PPCM患者共6 742例,其中41.9%治愈,45.1%好转,13.0%治疗无效或死亡。产后6个月内恢复正常/显著改善者有763例,占85.3%,产后6个月以上仍无法缓解者134例,占14.8%。对于有明确报道死亡原因的101例患者中,顽固性心力衰竭是首位死因,占54.5%,其次为血栓栓塞。结论:妊娠期感染、营养不良、围生期高血压等对PPCM有很大影响,与预后等相关。
Objective: This study was aimed to summarize the clinical characteristics and prognosis of patients with peripartum cardiomyopathy(PPCM). Methods: ology: All relevant literatures about PPCM published before November 2018 were identified by searching the Pubmed, Wanfang, CNKI and CBM databases. Results: A total of 2 340 papers were retrieved and 9 071 cases were reported in the 351 eligible papers. The average age of PPCM patients was(28.24±8.50) years. Primiparas took up 49.9%, and 50.1% of patients were postpartum women. Data showed that 61.3% of patients suffered from PPCM after partum and 38.7% of patients were with antenatal onset. Of the 3 187 patients included in the analysis, 38.6% were complicated by anemia, 17.4% with infection, 30.2% with hypertension, and 4.6% with malnutrition. 84.2% of the patients had different degree of left heart enlargement, with an average EF value of(36.24±7.10)%. The mean hospitalization time of PPCM patients was(19.23±12.11) days. Among the 6 742 patients included in the current analysis, 41.9% were cured, 45.1% improved, and 13.0% turned worse or even died. In the following six months after discharge, 763 cases rehabilitate completely or got significant improvement, accounting for 85.3%, and there were 134 cases who still failed to recover, which represented 14.8%. Totally 101 patients had a clear report about the causes of death, among which refractory heart failure took the first place, accounting for 54.5%; thromboembolism came second. Conclusions: Puerperal infection, malnutrition and perinatal hypertension are closely associated with the prognosis of PPCM.
Objective: This study was aimed to summarize the clinical characteristics and prognosis of patients with peripartum cardiomyopathy(PPCM). Methods: ology: All relevant literatures about PPCM published before November 2018 were identified by searching the Pubmed, Wanfang, CNKI and CBM databases. Results: A total of 2 340 papers were retrieved and 9 071 cases were reported in the 351 eligible papers. The average age of PPCM patients was(28.24±8.50) years. Primiparas took up 49.9%, and 50.1% of patients were postpartum women. Data showed that 61.3% of patients suffered from PPCM after partum and 38.7% of patients were with antenatal onset. Of the 3 187 patients included in the analysis, 38.6% were complicated by anemia, 17.4% with infection, 30.2% with hypertension, and 4.6% with malnutrition. 84.2% of the patients had different degree of left heart enlargement, with an average EF value of(36.24±7.10)%. The mean hospitalization time of PPCM patients was(19.23±12.11) days. Among the 6 742 patients included in the current analysis, 41.9% were cured, 45.1% improved, and 13.0% turned worse or even died. In the following six months after discharge, 763 cases rehabilitate completely or got significant improvement, accounting for 85.3%, and there were 134 cases who still failed to recover, which represented 14.8%. Totally 101 patients had a clear report about the causes of death, among which refractory heart failure took the first place, accounting for 54.5%; thromboembolism came second. Conclusions: Puerperal infection, malnutrition and perinatal hypertension are closely associated with the prognosis of PPCM.
引文
[1] Bauersachs J, Arrigo M, Hilfiker-Kleiner D, et al. Current management of patients with severe acute peripartum cardiomyopathy: practical guidance from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. Eur J Heart Fail, 2016, 18:1096-1105.
[2] Patel PA, Roy A, Javid R, et al. A contemporary review of peripartum cardiomyopathy. Clin Med (Lond), 2017, 4: 316-321.
[3] 王春玲,石宁,邹阳春,等.心律失常性右心室心肌病一例分析.中华全科医师杂志,2010,9:654-656.
[4] 谢后蓉,孙妍,吴山,等.典型限制型心肌病一例心脏超声诊断分析.中国心血管病研究,2013,11:832.
[5] Hilfiker-Kleiner D, Sliwa K. Pathophysiology and epidemiology of peripartum cardiomyopathy. Nat Rev Cardiol, 2014,11: 364-370.
[6] Lee YZJ, Judge DP. The Role of Genetics in Peripartum Cardiomyopathy. J Cardiovasc Transl Res,2017,10:437-445.
[7] 潘国忠,刘文玲,胡大一,等.散发性肥厚型心肌病β肌球蛋白重链及肌钙蛋白T基因突变的研究.中华老年心脑血管病杂志,2007,9:817-819.
[8] Arany Z, Elkayam U.Peripartum cardiomyopathy. Circulation, 2016,133:1397-1409.
[2] Patel PA, Roy A, Javid R, et al. A contemporary review of peripartum cardiomyopathy. Clin Med (Lond), 2017, 4: 316-321.
[3] 王春玲,石宁,邹阳春,等.心律失常性右心室心肌病一例分析.中华全科医师杂志,2010,9:654-656.
[4] 谢后蓉,孙妍,吴山,等.典型限制型心肌病一例心脏超声诊断分析.中国心血管病研究,2013,11:832.
[5] Hilfiker-Kleiner D, Sliwa K. Pathophysiology and epidemiology of peripartum cardiomyopathy. Nat Rev Cardiol, 2014,11: 364-370.
[6] Lee YZJ, Judge DP. The Role of Genetics in Peripartum Cardiomyopathy. J Cardiovasc Transl Res,2017,10:437-445.
[7] 潘国忠,刘文玲,胡大一,等.散发性肥厚型心肌病β肌球蛋白重链及肌钙蛋白T基因突变的研究.中华老年心脑血管病杂志,2007,9:817-819.
[8] Arany Z, Elkayam U.Peripartum cardiomyopathy. Circulation, 2016,133:1397-1409.