CAJ | 학술논문

目的：探讨围产期心肌病（PPCM）患者心室结构和功能变化、心率变异性（HRV）和炎症因子的相互关系。方法研究对象为2007年6月至2012年6月收集的在新疆医科大学第一附属医院产科住院的PPCM患者30例作为PPCM组，选择同期住院分娩、年龄相匹配的30例正常孕妇为对照组。行24小时动态心电图检查，检测心率变异性时域指标（ SDNN、RMSSD、SDANN和PNN50），同时检测PPCM超声心动图指标（心室内径、室间隔厚度和幅度）变化。结果30例PPCM患者左心室内径、右心室内径、室间隔厚度、左心室后壁厚度均大于对照组（t 值分别为4．256、3．636、2．012、2．003，均P＜0．05），而室间隔幅度、左心室后壁幅度和LVEF低于对照组（t值分别为3．027、4．015、6．003，均P＜0．05）。 PPCM组SDNN、SDANN、RMSSD、PNN50均低于对照组，差异有统计学意义（t 值分别为4．012、3．158、3．140、2．235，均P＜0．05）。 PPCM组hs-CRP值高于对照组，差异有统计学意义（t＝2．303，P＜0．05）。相关分析发现，hsCRP 与SDNN、SDANN、RMSSD、PNN50呈负相关（r 值分别为－0．568、－0．385、－0．328、－0．273，均P＜0．05），与左心室内径和室间隔厚度呈正相关（r 值分别为3．89、5．57，均P＜0．05）。结论PPCM患者亚临床炎症、自主神经失衡和心室重构有关，随着hs-CRP水平升高，心室重构明显加重，时域指标明显下降。
목적：탐토위산기심기병（PPCM）환자심실결구화공능변화、심솔변이성（HRV）화염증인자적상호관계。방법연구대상위2007년6월지2012년6월수집적재신강의과대학제일부속의원산과주원적PPCM환자30례작위PPCM조，선택동기주원분면、년령상필배적30례정상잉부위대조조。행24소시동태심전도검사，검측심솔변이성시역지표（ SDNN、RMSSD、SDANN화PNN50），동시검측PPCM초성심동도지표（심실내경、실간격후도화폭도）변화。결과30례PPCM환자좌심실내경、우심실내경、실간격후도、좌심실후벽후도균대우대조조（t 치분별위4．256、3．636、2．012、2．003，균P＜0．05），이실간격폭도、좌심실후벽폭도화LVEF저우대조조（t치분별위3．027、4．015、6．003，균P＜0．05）。 PPCM조SDNN、SDANN、RMSSD、PNN50균저우대조조，차이유통계학의의（t 치분별위4．012、3．158、3．140、2．235，균P＜0．05）。 PPCM조hs-CRP치고우대조조，차이유통계학의의（t＝2．303，P＜0．05）。상관분석발현，hsCRP 여SDNN、SDANN、RMSSD、PNN50정부상관（r 치분별위－0．568、－0．385、－0．328、－0．273，균P＜0．05），여좌심실내경화실간격후도정정상관（r 치분별위3．89、5．57，균P＜0．05）。결론PPCM환자아림상염증、자주신경실형화심실중구유관，수착hs-CRP수평승고，심실중구명현가중，시역지표명현하강。
Objective To investigate the relationship among ventricular structure , function variation , heart rate variability ( HRV ) and inflammatory factors in patients with peripartum cardiomyopathy (PPCM).Methods From June 2007 to June 2012 30 cases of PPCM were admitted in the First Affiliated Hospital of Xinjiang Medical University and were selected in PPCM group .Another 30 hospitalized cases of normal women with similar age were selected in control group .HRV indexes ( SDNN, RMSSD, SDANN and PNN50) and ultrasound cardiogram indexes ( ventricle diameter , interventricular septal thickness and septal margin ) were detected by 24-hour dynamic electrocardiogram .Results The left ventricular internal diameter , right ventricular internal diameter , interventricular septal thickness and left ventricular posterior wall thickness in PPCM group were significantly higher than those in the control group (t value was 4.256, 3.636, 2.012 and 2.003, respectively, all P<0.05), but the margin of interventricular septum , left ventricular posterior wall and left ventricular ejection fraction (LVEF) were significantly decreased than those in the control group (t value was 3.027, 4.015 and 6.003, respectively, all P<0.05).The SDNN, SDANN, RMSSD and PNN50 in PPCM group were significantly decreased than those in the control group (t value was 4.012, 3.158, 3.140 and 2.235, respectively, all P<0.05).The high sensitivity C-reactive protein ( hs-CRP) in PPCM group was significantly higher than that in the control group (t =2.303, P <0.05).Correlation analysis showen that hs-CRP was negatively correlated with SDNN, SDANN, RMSSD and PNN50 (r value was -0.568, -0.385, -0.328 and -0.273, respectively, all P<0.05), but positively correlated with left ventricular inner diameter and thickness of the interventricular septum (r value was 3.89 and 5.57, respectively, both P<0.05).Conclusion Subclinical inflammation and autonomic nervous disturbances are correlated with ventricular reconstruction in PPCM patients .With the increasing of hs-CRP, ventricular remodeling increases significantly and the time domain indexes decrease significantly .