扩张型心肌病的分期及其临床意义

目的 :探讨扩张型心肌病 (DCM)的临床分期 ,评价 DCM不同阶段干预治疗的效果。方法 :将来自国内16所医院的 DCM患者 2 2 1例 ,按 NYHA心功能分级标准进行临床分期 :无心力衰竭 (心衰 )期 ,心衰期和心衰晚期。采用随机单盲安慰剂对照试验 ,在心衰治疗基础上 ,加用地尔硫 6 0 m g/ d或安慰剂 ,借助心肌病分期方案 ,评价地尔硫对 DCM的干预试验。结果 :单纯治疗心衰对于 DCM无心衰期患者的心功能参数没有显著性影响 ,心衰期患者心功能参数均明显减退 ,心衰晚期患者心功能参数无明显变化。加用地尔硫治疗 DCM,能够显著改善无心衰期和心衰期患者的心功能参数 ,而心衰晚期患者心功能参数无明显改善。预后分析发现安慰剂组需要反复住院治疗人数和病死率均显著高于地尔硫组。结论 :对 DCM进行临床分期 ,有助于疾病的早期诊断和全面评价干预试验 ,具有临床实用价值。应用地尔硫对 DCM早期干预 ,将改变 DCM自然进程 ,提高患者生活质量和生存率。

Clinical stages and significance in dilated cardiomyopathy

Objective:To research for clinical dividing dilated cardiomyopathy (DCM) into stages and effects of intervention on different stage of DCM.Method:The study was carried out on 221 patients with DCM from 16 hospitals in China.Based on NYHA function grade,trying to divided DCM into 3 clinical stages,that were no heart failure (HF) stage,HF stage and late HF stage.Diltiazem 60 mg daily or placebo was given randomly and monoblindly to them who had received basic treatment for heart failure.Result:During basic treatment,there was no change of heart function in no HF group;the heart function reduced markedly in HF group.When diltiazem was added to the basic treatment,the parameters of heart function were improved significantly in no HF group and HF group;and there was no effect on the late HF group.Repeated hospitalization and mortality were significantly reduced in the diltiazem group.Conclusion:Dividing DCM into 3 clinical stages is beneficial to early diegnosis and early intervention.Diltiazem intervention in early stage of DCM may change the natural course of disease and improving life quality of patients.