扩张型心肌病的相关危险因素研究

目的 探讨扩张型心肌病(DCM)与环境化学元素、病毒感染及其他相关因素的关系.方法 2008年,在山东省阳谷县人民医院选择233例DCM患者(病例组)与150例稳定型心绞痛患者(对照组),对2组患者进行一般情况、疾病史调查,应用酶联免疫吸附试验(ELISA)测定病例组和对照组血清中人心肌抗体-IgG、柯萨奇B组病毒-IgG及腺病毒-IgG,应用原子吸收光谱法测定血清铜、锌、钙、镁、铁、锰等微量元素水平.并测定DCM高发区(阳谷县)和低发区(高唐县和临清市)饮用水一般化学指标及毒理指标.结果 ①病例组农民的比例[77.68%(181/233)]高于对照组[60.00%(90/150),χ2=13.8,P<0.01)],病例组人均年收入[(3207.82±618.51)元]低于对照组[(5086.61±886.12)元,t=24.40,P<0.01],病例组人均饮酒量[(175.02±160.50)g/d]高于对照组[(110.22±100.03)g/d,t=4.40,P<0.01],病例组心肌炎病史比例[5.15%(12/233)]高于对照组[0.67%(1/150),χ2=5.60,P<0.01].②DCM病人心肌抗体-IgG、人柯萨奇B组病毒-IgG及人腺病毒-IgG的阳性率分别为7.78%(7/90)、6.67%(6/90)及6.67%(6/90),对照组阳性率分别为3.33%(2/60)、5.00%(3/60)及5.00%(3/60),二者比较差异均无统计学意义(χ2值分别为1.26、0.18、0.18;P均>0.05).③DCM高发区饮用水含铁量、含锰量[(1.36±2.18)mg/L、(0.38±0.35)mg/L]高于低发区[(0.39±0.67)mg/L,(0.15±0.14)mg/L,t值分别为2.11、3.01,P均<0.01].④病例组血清含铁量[(69.1±57.8)μmol/L]高于正常值(15.6～35.9 μmol/L),且高于对照组[(20.0±17.5)μmol/L,t=5.04,P<0.01].结论 不支持DCM的发生与持续性病毒感染和自身免疫反应有关;DCM的发病可能与经济收入、饮酒量、心肌炎、饮用水中铁和锰及血清铁水平超标有一定关系.

Primary analysis of risk factors related to dilated cardiomyopathy

Objective To study the relationship between environmental chemical elements,vires infection and dilated cardiomyopathy(DCM).Methods In 2008,233 patients with DCM(case group)and 150 patient with stable angina(control group)were chosen in Liaocheng People's Hospital and Yanggu People's Hospital,Shandong province.Population distribution and disease history were surveyed in the two groups.Human myocardial antibody IgG(AMA-IgG),Coxsackie B virus IgG(CBV-IgG),Adenofirus antibody IgG(ADV-IgG)were detected by ELISA in both the case group and the control group.Serum trace elements were detected in the two groups.The general chemical and toxicological indicators in drinking water of the high-and the low-incidence aireas of the disease were control group[60.00%(90/150),χ2=13.80,P<0.01)].Per capita annual income(Yuan,RMB)in the case group (3207.82±618.51)was lower than that of the control group[(5086.61±886.12),t=24.40,P<0.01].Personal alcohol consumption in the case group[(175.00±160.50)g/d]was higher than that of the control group[(110.22±100.03)g/d,t=4.40,P<0.01)].The rate of myocarditis in the case group[5.15%(12/233)]was higher than ADV-IgG in the cage group were 7.78%(7/90),6.67%(6/90)and 6.67%(6/90),respectively.Compared with those in the control group[3.33%(2/60),5.00%(3/60)and 5.00%(3/60),χ2=1.26,0.18,0.18,all P>0.05],no mg/L]in drinking water of the high-incidence areas were significantly higher than that of iron[(0.39±0.67)mg/L,t=2.11,P<0.05]and that of manganese[(0.15±0.14)mg/L,t=3.01,P<0.01]in the low-incidence arefas.The content of semm iron[(69.1±57.8)μmol/L]in the case group evidently exceeded the normal range(15.6-35.9 μmol/L)and obviously higher than that in the control group[(20.0±17.5)μmol/L,t=5.04,P<0.01].Conclusions Theso data do not support that DCM is related with persistent virus infection and autoimmunization.DCM is probably related with low incomes,high alcohol consumption,myocarditis,high iron and manganese contents in drinking water and high content of serum iron.