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。

Comparative analysis of risk factors for coronary heart disease,serum lipid levels,and echocardiographic features between patients with dilated cardiomyopathy and ischemic cardiomyopathy

ObjectiveTo compare the risk factors for coronary heart disease, blood lipids, and echocardiographic features between patients with dilated cardiomyopathy (DCM) and ischemic cardiomyopathy (ICM) to help doctors in primary hospitals diagnose and identify the two heart diseases. MethodsFifty-three patients treated at the Second Affiliated Hospital of Shantou University Medical College from January 2015 to August 2017 were divided into a DCM group (33-79 years old, 34 cases) and an ICM group (41-77 years old, 19 cases). All patients had cardiac enlargement and underwent coronary angiography to confirm coronary artery disease. The risk factors for coronary heart disease, blood lipids, and echocardiographic characteristics were analyzed. ResultsIn terms of age composition, the proportion of young and middle-aged patients (<40 years old) in the DCM group was significantly higher than that in the ICM group (20.59% vs 0, χ²=4.51, P=0.034). However, the proportion of old patients (≥60 years old) in the DCM group was significantly lower than that in the ICM group (32.35% vs 68.42%, χ²=6.40, P=0.011). Regarding risk factors for coronary heart disease, male patients accounted for 81.13% of all patients. However, there was no statistically significant difference in the proportion of male patients between the DCM group and ICM group (82.35% vs 78.95%, χ²=0.09, P=0.761). The proportion of patients with hypertension and diabetes in the ICM group was significantly higher than that in the DCM group (73.68% vs 38.24%, χ²=6.13, P=0.013; 52.63% vs 20.59%, χ²=5.74, P=0.017), but the rate of patients with smoking had no significant difference between the two groups (58.82% vs 57.89%, χ²=0.00, P=0.948)). With regard to blood lipid levels, there was no significant difference in the levels of triglycerides or high density lipoprotein cholesterol between the two groups [(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]. The levels of total cholesterol and low density lipoprotein cholesterol in the DCM group were significantly lower than those in the ICM group [(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)]. In terms of echocardiographic features, the left ventricular system expansion degree of patients in the DCM group was significantly greater than that in the ICM group. The left atrial diameter, left ventricular end-diastolic diameter, and left ventricular end-systolic diameter of patients in the DCM group were all larger than those in the ICM group [(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)]. Compared with the ICM group, patients in the DCM group had higher proportion of right heart system enlargement(44.12% vs 15.79%, χ²=4.36, P=0.037), but the ejection fraction was mostly decreased [(31.65±7.18)% vs (36.89±9.10)%, t=-2.31, P=0.025]). ConclusionComprehensive analysis of risk factors for coronary heart disease, blood lipids, and echocardiography features can be used to identify DCM and ICM.