原发性扩张型心肌病的心肌异常收缩反应

目的探讨原发性扩张型心肌病(DCM)的心肌异常收缩反应。方法应用多巴酚丁胺超声心动图负荷试验(DSE)测定18例DCM患者在基础状态和多巴酚丁胺剂量为5、10、20μg·kg-1·min-1时的室壁运动改变。DSE时室壁收缩反应分为运动改善、无改善、运动恶化、双相反应四类,无改善、运动恶化和双相反应定义为心肌异常收缩反应,其中运动恶化和双相反应定义为类缺血反应。结果18例患者全部存在室壁心肌异常收缩反应(100%),13例存在类缺血反应(72.2%)。总计225个有效心肌节段中,126节段诱发出异常收缩反应(56.0%),其中97段为无改善(43.1%),29段为类缺血反应(12.9%)。运动改善发生率在2分的节段最高(62.1%),类缺血反应发生率在3分节段最高(24.6%),无改善发生率在4分节段最高(68.4%)。结论DSE可诱发出DCM心肌异常收缩反应,推测DCM存在以缺血为表现形式的心肌能量供需失衡。     

Myocardial electrical propagation in patients with idiopathic dilated cardiomyopathy.

Myocardial propagation may contribute to fatal arrhythmias in patients with idiopathic dilated cardiomyopathy (IDC). We examined this property in 15 patients with IDC undergoing cardiac transplantation and in 14 control subjects. An 8 x 8 array with electrodes 2 mm apart was used to determine the electrical activation sequence over a small region of the left ventricular surface. Tissue from the area beneath the electrode array was examined in the patients with IDC. The patients with IDC could be divided into three groups. Group I (n = 7) had activation patterns and estimates of longitudinal (theta L = 0.84 +/- 0.09 m/s) and transverse (theta T = 0.23 +/- 0.05 m/s) conduction velocities that were no different from controls (theta L = 0.80 +/- 0.08 m/s, theta T = 0.23 +/- 0.03 m/s). Group II (n = 4) had fractionated electrograms and disturbed transverse conduction with normal longitudinal activation, features characteristic of nonuniform anisotropic properties. Two of the control patients also had this pattern. Group III (n = 4) had fractionated potentials and severely disturbed transverse and longitudinal propagation. The amount of myocardial fibrosis correlated with the severity of abnormal propagation. We conclude that (a) severe contractile dysfunction is not necessarily accompanied by changes in propagation, and (b) nonuniform anisotropic propagation is present in a large proportion of patients with IDC and could underlie ventricular arrhythmias in this disorder.     

Blood pressure variability as sign of autonomic imbalance in patients with idiopathic dilated cardiomyopathy

Background: The problem of identifying idiopathic dilated cardiomyopathy (IDC) patients who are at risk of sudden death is still unsolved. The presence of autonomic imbalance in patients with IDC might predict sudden death and tachyarrhythmic events. The aim of this study was to analyze the suitability of blood pressure variability (BPV) compared to heart rate variability (HRV) for noninvasive risk stratification in IDC patients. Methods: Continuous noninvasive blood pressure and high‐resolution electrocardiogram were recorded from 91 IDC patients for 30 minutes. During a median follow‐up period of 28 months (range: [17–38] months), 14 patients died due to sudden death or necessary resuscitation due to a life‐threatening arrhythmia. HRV and BPV analyses were performed in time domain, frequency domain, and nonlinear dynamics. Using the Mann‐Whitney U test and Cox regression, we estimated the accuracy of clinical and nonclinical parameters in discriminating high‐risk from low‐risk patients. Results: Dynamics of blood pressure regulation was significantly changed in high‐risk patients, indicating an increased BPV. BPV indexes from nonlinear symbolic dynamics revealed significant univariate (sensitivity: 85.7%; specificity 77.9%; area under receiver‐operator characteristics [ROC] curve: 87.8%) differences. In an optimum multivariate set consisting of two clinical indexes (left ventricular end‐diastolic diameter, New York Heart Association) and one nonlinear index (symbolic dynamics), highly significant differences between low‐ and high‐risk IDC groups were estimated (sensitivity of 92.9%, specificity of 86.5%, and area under ROC curve of 95.3%). Conclusion: Diastolic BPV indexes, especially those from symbolic dynamics, appear to be useful for risk stratification of sudden death in patients with IDC. PACE 2012; 35:471–479)     

Features of mildly dilated congestive cardiomyopathy compared with idiopathic restrictive cardiomyopathy and typical dilated cardiomyopathy

Congestive cardiomyopathy was recognized in eight patients with only mildly dilated ventricles (an echocardiographic ventricular diastolic dimension index of less than 10% to 15% above the normal range) but with other features typical of end-stage congestive cardiomyopathy. Such patients with mildly dilated cardiomyopathy (MDCM) represented 5% of heart transplant recipients with cardiomyopathy, who were analyzed by us. The clinical, echocardiographic, and hemodynamic data, as well as the gross and microscopic pathologic findings of the hearts in this group were compared with similar data in five patients with idiopathic restrictive cardiomyopathy (IRCM) and 10 patients with typical dilated cardiomyopathy (DCM). Compared with IRCM and DCM, patients with MDCM had a higher incidence of familial cardiomyopathy (p less than 0.009). The echocardiographic features of patients with MDCM and DCM were virtually identical, showing globular hearts with predominant left ventricular dilation and diffuse poor left ventricular contraction. Patients with IRCM had marked atrial dilation but less abnormality of left ventricular size and contraction parameters. On the basis of echocardiographic data, patients with IRCM and MDCM could be well segregated. Cardiac index and light microscopic examinations were similar in the three groups. However, electron microscopy showed a lack of myofibrillar loss in patients with IRCM, little or no myofibrillar loss in those with MDCM, and almost total myofibrillar loss in those with DCM. Patients with MDCM have a high prevalence of familial cardiomyopathy. Absolute heart size and electron microscopic features of the MDCM group were intermediate between IRCM and DCM, but other clinical, echocardiographic and hemodynamic findings were similar to typical DCM.     

Heavy metal and trace element concentrations in patients with idiopathic dilated cardiomyopathy

Blood, serum and urine concentrations (24 hour samples) of cadmium, lead, magnesium, calcium, zinc, copper and iron were determined by means of atomic absorption spectrophotometry in 54 patients with dilated cardiomyopathy (CMP). These data were compared with the values in 17 healthy controls. CMP patients showed higher blood cadmium concentrations (+173%, p less than 0.001), higher serum calcium concentrations (+4%, p less than 0.01) and lower serum magnesium levels (-11%, p less than 0.01). In urine samples CMP patients had higher cadmium levels and lower concentrations of calcium (-43%, p less than 0.05) and magnesium (-36%, p less than 0.05). Correlations with clinical data revealed no definite reason for the abnormal laboratory findings in CMP patients. In individual cases, however, the high cadmium concentrations could be of aetiological importance.     

缺血性与非缺血性心肌病左室收缩不同步的对比研究

目的：应用组织同步显像技术（Tissue synchronization imaging,TSI）评价缺血性心肌病（ICM）和扩张型心肌病（DCM）心力衰竭患者左室内收缩的不同步性。方法：ICM患者20例（ICM组）和DCM患者23例（DCM组）作为病例组,30例健康志愿者作为对照组,采集心尖四腔观、心尖二腔观及心尖长轴观三个心动周期的组织速度图像。启动TSI模式,获取左室六个壁12个取样点心肌组织的达峰值速度时间（TS）,计算间隔后壁间延迟（△TS-P）、间隔侧壁间延迟（△TS-L）、基底段最大延迟（△TB-max）、基底段达峰值时间标准差（△TB-SD）、所有节段最大延迟（△Tmax）和左室所有节段标准差（TSD）。对比ICM组、DCM组及对照组之间左室收缩不同步性的差异。结果：ICM组和DCM组六个壁的TS均高于对照组（P<0.05或P<0.01）,在各同步性参数中,与对照组相比,ICM组和DCM组Tmax、TSD、△TB-max和△TB-SD明显延长,差异有统计学意义（P<0.05）,ICM组和DCM组间比较,仅TSD差异有统计学意义（P<0.05）,ICM组最大延迟的部位多发生在室间隔和下壁,DCM组最大延迟的部位多位于侧后壁。结论：ICM和DCM心衰患者左室壁收缩明显不同步,且二组之间的不同步存在差异。     

风湿性心脏病和扩张型心肌病患者血脂与载脂蛋白测定结果分析

目的通过测定风湿性心脏病(RHD)和扩张型心肌病(DCM)患者血脂与载脂蛋白水平,探讨RHD和DCM患者血脂与载脂蛋白异常的意义.方法 86例RHD患者、50例DCM患者和106例健康体检者,采用酶法测定血脂.免疫比浊法测定载脂蛋白.结果 RHD和DCM患者血脂代谢异常主要表现为血脂和载脂蛋白的普遍降低,尤其是总胆固醇(TC)、低密度脂蛋白胆固醇( LDL-C)、载脂蛋白B(Apo B)在DCM组降低明显,异常率分别达40.0%、40.0%、70.0%;与对照组相比,RHD和DCM患者TC、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A-I(Apo AI)均降低(P<0.05),而DCM组同时伴LDL-C和Apo B明显降低(P<0.05);与RHD组比较,DCM组LDL-C和Apo B明显降低(P<0.05,0.001).结论 RHD和DCM患者的血脂和载脂蛋白普遍降低,DCM患者降低更明显,对RHD和DCM患者不应盲目采取降血脂治疗.     

氟伐他汀对扩张型心肌病患者血炎症介质及心功能的影响

目的研究氟伐他汀对扩张型心肌病患者血清细胞因子水平及心功能的影响。方法心功能Ⅱ、Ⅲ级的扩张型心肌病患者随机分为2组．氟伐他汀组（n=32例）每日口服氟伐他汀40mg，对照组（30例）不用降脂药物：于研究开始及6个月结束时监测血清肿瘤坏死因子d（TNF—d1、白细胞介素-6（IL-6）、血清超敏C反应蛋白（hs—CRP）水平．监测肝酶及肌酶变化及左心室射血分数（LVEF）。结果氟伐他汀组及对照组治疗后的LVEF均较治疗前明显改善．差异有统计学意义（t分别=5．75、6．78，P均〈0．05）；两组的血TNF—a、IL-6及hs—CRP水平在治疗前后比较，差异均无统计学意义（t分别=1．37、O．46、1．73、0.37、0．63、0．46，P均〉0．05）；但对于心功能Ⅲ级患者氟伐他汀组能显著降低血TNF—a、IL-6水平（t分别=2，55、2．77，P均〈0．05），与对照组治疗后比较，差异也有统计学意义（t分别=2．13、2．05，P均〈0．05）。治疗后的氟伐他汀组LVEF较对照组明显提高（t=2．80，P〈0．05）。结论对心功能Ⅲ级的扩张型心肌病患者使用氟伐他汀治疗有一定的治疗价值，但对扩张型心肌病患者中常规缺乏依据。     

Direct evidence for a beta 1-adrenergic receptor-directed autoimmune attack as a cause of idiopathic dilated cardiomyopathy

Today, dilated cardiomyopathy (DCM) represents the main cause of severe heart failure and disability in younger adults and thus is a challenge for public health. About 30% of DCM cases are genetic in origin; however, the large majority of cases are sporadic, and a viral or immune pathogenesis is suspected. Following the established postulates for pathogenesis of autoimmune diseases, here we provide direct evidence that an autoimmune attack directed against the cardiac beta(1)-adrenergic receptor may play a causal role in DCM. First, we immunized inbred rats against the second extracellular beta(1)-receptor loop (beta(1)-EC(II); 100% sequence identity between human and rat) every month. All these rats developed first, receptor-stimulating anti-beta(1)-EC(II) Ab's and then, after 9 months, progressive severe left ventricular dilatation and dysfunction. Second, we transferred sera from anti-beta(1)-EC(II)-positive and Ab-negative animals every month to healthy rats of the same strain. Strikingly, all anti-beta(1)-EC(II)-transferred rats also developed a similar cardiomyopathic phenotype within a similar time frame, underlining the pathogenic potential of these receptor Ab's. As a consequence, beta(1)-adrenergic receptor-targeted autoimmune DCM should now be categorized with other known receptor Ab-mediated autoimmune diseases, such as Graves disease or myasthenia gravis. Although carried out in an experimental animal model, our findings should further encourage the development of therapeutic strategies that combat harmful anti-beta(1)-EC(II) in receptor Ab-positive DCM patients.     

Apheresis in the treatment of idiopathic dilated cardiomyopathy

Dilated cardiomyopathy (DCM) causes significant morbidity and mortality and is the number one indication for cardiac transplantation in the United States. A large percentage of cases of DCM have no identifiable cause with evidence suggesting that these may represent an autoimmune disorder triggered by viral myocarditis. There is a growing body of literature suggesting that a number of immunoadsorption techniques, as well as plasma exchange, may have a role in the treatment of idiopathic DCM. The hypothesized autoimmune mechanism behind idiopathic DCM as well as the published evidence for the use of apheresis in this disorder are reviewed. The available evidence suggests that apheresis may be an effective treatment, but additional research is needed to identify markers that will predict response and the most effective apheresis technique. J. Clin. Apheresis 2012. © 2012 Wiley Periodicals, Inc.     

The clinical importance of the dynamic determination of the serum neopterin level in patients with dilated cardiomyopathy]

Serum neopterin was measured over time (from 3 to 24 months) by RIA in 15 patients with dilated cardiomyopathy. Comparison with the clinical data revealed that the initially normal concentration of neopterin (less than 9 nM/l) was associated with a stable disease course on a long-term observation (group I). The second group with an initially high neopterin concentration showed an objective improvement of the health status together with normalization of the neopterin level. The third group of patients were characterized by an increase of the neopterin level measured over time, coupled with a disease progress. It should be noted that 5 out of 8 patients died. In addition to neopterin measurements, the patients with dilated cardiomyopathy were examined for serum beta-2-microglobulin (beta-2M). Analysis of the data obtained has demonstrated a similar relationship between the level of neopterin and beta-2M and the clinical course of dilated cardiomyopathy. Still, neopterin is a more sensitive marker. Therefore, the data obtained attest to a possibility of the use of serum neopterin as a prognostic marker in patients suffering from dilated cardiomyopathy.     

Prognostic significance of soluble interleukin-2 receptor levels in patients with dilated cardiomyopathy

BACKGROUND: Activation of T lymphocytes is thought to mediate myocardial dysfunction in dilated cardiomyopathy (CMP), probably through cytotoxic cytokines, but its value as a prognostic factor has not been evaluated. METHODS: For 2 years we prospectively followed 76 patients (65 males, 11 females, age 49 +/- 7 years) with CMP and New York Heart Association(NYHA) Class II-III heart failure; left ventricular (LV) function was assessed echocardiographically. Thirty-three patients (28 males, five females, age 52 +/- 6 years) with ischaemic heart disease (IHD) and similar NYHA and LV function characteristics were used as controls. Serum sIL-2R levels, peripheral blood lymphocyte proliferation (basal, + concanavalin A) and HLA-DQB1 genotyping was carried out in all patients. RESULTS: The CMP patients had increased sIL-2R levels (1259 +/- 130 pg mL-1) compared with the IHD patients (703 +/- 80 pg mL-1, P < 0.01, only 3 > 800 pg mL-1). In the CMP patients, there was a significant (r = +0.45, P= 0.04) correlation between sIL-2R and the LV end-diastolic diameter but not with the LV ejection fraction or NYHA Class. During the 24-month follow up, 17 of the CMP patients had an adverse clinical course (death, need for cardiac transplantation, or worsening heart failure). Of these, 14 (75%) had elevated (>or= 800 pg mL-1) sIL-2R levels (Group I) compared with only five (6%) with a stable clinical course (Group II). Neither [3H] thymidine incorporation into the peripheral blood lymphocytes nor the excess of HLA-DQB1-30 histidine homozygotes in the Group I patients (38% vs. 17%, P < 0.05) could predict the clinical outcome. CONCLUSION: Increased sIL-2R levels in CMP patients are an independent predictor of a more aggressive clinical course.     

Cardiac sympathetic activity is associated with inflammation and neurohumoral activation in patients with idiopathic dilated cardiomyopathy

Background: Idiopathic dilated cardiomyopathy (IDC) is characterized by sympathetic nervous overactivity, inflammation and neurohumoral activation; however, their interrelationships are poorly understood. Methods and results: We studied 99 patients with IDC (age 54 ± 1 years, left ventricular ejection fraction (EF) 40 ± 1%, maximum oxygen uptake (VO₂max) 20 ± 1 ml kg^?1 min^?2, mean ± SEM) by using ¹²³I‐metaiodobenzylguanidine (MIBG) imaging. MIBG washout and MIBG heart/mediastinum (H/M)‐ratio at 4 h postinjection were calculated. In addition, the plasma levels of interleukin (IL)‐6 and N‐terminal B‐type natriuretic peptide (NT‐proBNP) were measured. MIBG washout and MIBG H/M ratio had a significant correlation with IL‐6 (r = 0·42, P<0·001 and r = ?0·31, P<0·01) and NT‐proBNP (r = 0·48, P<0·001 and r = ?0·40, P<0·001). During a median follow‐up of 4·1 years, 20 patients (20%) had an adverse cardiac event (death, heart transplantation or application of biventricular pacemaker or implantable cardioverter–defibrillator). In these patients, MIBG washout was higher (53 ± 4 versus 40 ± 2%, P = 0·01) and H/M ratio lower (1·38 ± 0·04 versus 1·51 ± 0·02, P = 0·01) than in patients without an event. Conclusions: In dilated cardiomyopathy, myocardial sympathetic innervation and activity are related to inflammation and neurohumoral activation. These relationships are at least partly independent of left ventricular function and exercise capacity.     

高分辨力超声评价扩张型心肌病患者肱动脉内皮功能

目的应用高分辨力超声测量扩张型心肌病患者反应性充血前后肱动脉内径的百分变化率评价肱动脉内皮功能.方法研究对象包括21例扩张型心肌病患者和18例健康对照者.应用高分辨力超声测量静息状态下、反应性充血后、舌下含服硝酸甘油后的肱动脉内径,并计算反应性充血和硝酸甘油诱发的内径百分变化率.结果反应性充血诱发的肱动脉内径百分变化率扩张型心肌病患者[(4.2±4.7)%]明显低于正常人[(11.4±3.7)%,P<0.001],硝酸甘油诱发的肱动脉内径百分变化率扩张型心肌病患者[(27.4±8.1)%]和健康对照者[(28.3±8.4)%,P=0.32]差别无显著统计学意义.结论扩张型心肌病患者肱动脉内皮功能减低.     

阿托伐他汀对扩张型心肌病患者细胞因子及心功能的影响

目的研究阿托伐他汀对扩张型心肌病患者血清细胞因子水平及心功能的影响，探讨他汀类药物应用于非缺血性心肌病的可行性。方法69例心功能NYHAⅠ、Ⅱ级的扩张型心肌病患者随机分为2组。阿托伐他汀组（35例）每日口服立普妥20mg，对照组（34例）不服用降脂药物。于实验开始及6个月结束时采用酶联免疫吸附法测定血清肿瘤坏死因子-α（TNF—α）、白细胞介素石（IL-6）水平；采用全自动免疫分析系统测定血清超敏C-反应蛋白（hs—CRP）水平，并测定血清总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、甘油三酯（TG）等水平的变化；通过超声心动图评价左心室舒张末期内径（LVEDD）、短轴缩短率（FS）、左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）及射血分数（EF）。结果①阿托伐他汀组较对照组TNF—α、IL-6、hs—CRP、TC、LDL-C水平及TC／HDL—C明显降低（均P〈0．01）；②阿托伐他汀组较对照组LVESV明显减低（P〈0．05），而FS、EF明显增高（均P〈0．01）。结论短期应用阿托伐他汀可以改善扩张型心肌病患者的心功能，降低血清炎性细胞因子和炎症标志物的水平。阿托伐他汀很可能成为治疗非缺血性心肌病的又一有效药物。     

扩张型心肌病与缺血性心肌病患者冠心病危险因素、血脂及心脏超声特征对比分析

目的对比分析扩张型心肌病(DCM)和缺血性心肌病（ICM）患者冠心病危险因素、血脂以及心脏超声特征,为基层医师诊断和初步鉴别这两种心脏疾病提供参考。 方法入选2015年1月至2017年8月在汕头大学医学院第二附属医院心内科住院的心脏扩大且合并左室收缩功能降低的53例患者,患者均行冠状动脉造影。按照冠状动脉造影结果将患者分为DCM组（34例,33~79岁）和ICM组（19例,41~77岁）,回顾性分析两组患者冠心病危险因素、血脂及心脏超声特征。采用χ²检验比较两组患者年龄构成情况、冠心病危险因素（性别、高血压、糖尿病、吸烟史）构成情况、右心系统增大构成情况,采用t检验比较血脂检查结果（总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇）和超声检查结果［左心房直径、左心室舒张末期内径（LVd）、左心室收缩末期内径（LVs）、射血分数］。 结果在年龄构成方面：DCM组中青年患者（<40岁）比例明显高于ICM组,差异具有统计学意义（20.59% vs 0,χ²=4.51,P=0.034）;而DCM组老年患者（≥60岁）比例明显低于ICM组,差异具有统计学意义（32.35% vs 68.42%,χ²=6.40,P=0.011）。在冠心病危险因素方面,所有心脏扩大患者中,男性患者占所有患者的81.13%;但是DCM组和ICM组在男性比例方面差异无统计学意义（82.35% vs 78.95%,χ²=0.09,P=0.761）;ICM组患者合并高血压、糖尿病的比例均明显高于DCM组,差异具有统计学意义（73.68% vs 38.24%,χ²=6.13,P=0.013;52.63% vs 20.59%,χ²=5.74,P=0.017）;DCM组和ICM组患者吸烟史比例差异无统计学意义（58.82% vs 57.89%,χ²=0.00,P=0.948）。在血脂水平方面,DCM组和ICM组患者甘油三酯、高密度脂蛋白胆固醇水平差异无统计学意义［（1.26±0.59）mmol/L vs （1.46±1.02）mmol/L,t=-0.91,P=0.369;（1.02±0.40）mmol/L vs （1.06±0.27） mmol/L,t=-0.39,P=0.699］;DCM组患者总胆固醇、低密度脂蛋白胆固醇水平低于ICM组,差异具有统计学意义［（4.37±1.10） mmol/L vs （5.23±1.32）mmol/L,t=-2.54,P=0.014;（2.80±0.82）mmol/L vs （3.43±1.02）mmol/L,t=-2.46,P=0.018］。在心脏超声检查方面,DCM组患者左心系统扩大程度较ICM组明显,DCM组患者左心房直径、LVd、LVs均大于ICM组,差异具有统计学意义［（43.29±6.19）mm vs（38.58±4.82）mm,t=2.86,P=0.006;（65.94±7.30）mm vs（58.94±9.16）mm,t=3.05,P=0.004;（54.68±8.43）mm vs （48.16±7.61）mm,t=2.79,P=0.007］;DCM组患者与ICM患者比较,右心系统扩大的比例更高,差异具有统计学意义（44.12% vs 15.79%,χ²=4.36,P=0.037）,射血分数下降更为明显,差异具有统计学意义［（31.65±7.18）% vs （36.89±9.10）%,t=-2.31,P=0.025］。 结论综合分析冠心病危险因素、血脂及心脏超声特征可初步鉴别DCM和ICM。     

扩张型心肌病患者心房颤动的临床意义

目的：探讨扩张型心肌病（ＤＣＭ）伴发心房颤动（ＡＦ）的临床意义。方法：将１９例ＤＣＭ伴ＡＦ者与５０例ＤＣＭ无ＡＦ者的临床、超声心动图及心电图资料进行对比分析。结果：ＤＣＭ并发ＡＦ者年龄老化〔（６５±１６）岁〕，心功能（ＮＹＨＡⅢ级～Ⅳ级者７８．９５％）差，栓塞率（２１．０５％）和病死率（３６．８４％）均高（Ｐ＜０．０５或Ｐ＜０．０１）；左室射血分数（０．２８±０．０９）、短轴缩短率（０．１５±０．０３）明显降低，心脏扩大发生率、室性心律失常及复合心律失常发生率高（Ｐ＜０．０５或Ｐ＜０．０１）。结论：ＤＣＭ的ＡＦ发生与年龄、心力衰竭、心室扩大、心肌病变相关，ＡＦ是预后不良的指标。     

高位硬膜外阻滞对原发性扩张型心有岂病自主神经功能的影响

目的　探讨高位硬膜外阻滞 (TEB)对原发性扩张型心肌病自主神经功能的影响。方法　 30例原发性扩张型心肌病患者 ,胸3～ 4或胸4～ 5棘突间隙穿刺至硬膜外腔 ,留置硬膜外导管 ,每 2h推注 0 5 %利多卡因 3～ 5mL至硬膜外腔 ,持续 4～ 8周 ,适当辅以常规治疗。测定并比较TEB治疗前后 4周 2 4h心率变异 (HRV)指标的差异。结果　TEB治疗 4周后 ,扩张型心肌病患者HRV指标明显提高 ,SDNN由 (75 18± 34 5 1)ms升高至 (110 93± 37 0 6 )ms,P <0 0 1;SDANN由 (6 2 35± 2 7 5 5 )ms升高至 (96 85± 4 0 2 6 )ms,P <0 0 1;LnLF由 5 76± 1 5 0升高至 6 85± 1 4 3,P <0 0 1。结论　TEB可明显提高原发性扩张型心肌病患者心率变异性 ,显著改善扩张型心肌病患者自主神经功能