【摘要】 目的 对克山病病区与非病区内扩张型心肌病患者的临床检查结果进行对比分析，探寻病区与非病区“扩心病”临床表现的差异，为病区内克山病筛查重点对象的确定提供参考依据。方法 采用回顾性调查的方法，随机抽取2021年1月—2022年10月大理大学第一附属医院心内科就诊的扩张型心肌病患者，并根据患者的常住地分为克山病病区组与非病区组。收集扩张型心肌病患者的临床资料，并对两组患者的临床特点、心功能、心脏结构改变进行分析。结果 本次调查共收集210例扩张型心肌病患者，平均年龄(55.1±11.8)岁。病区组109例，非病区组101例。NYHA分级均达到Ⅱ级及以上，其中心功能Ⅵ级比例较高，占39.5%。心电图异常改变主要表现为房颤、完全性右束支传导阻滞、室性早搏、传导阻滞、ST段改变。其中病区组房颤发生率29.4%,高于非病区组发生率16.8%(χ~2=4.598,P<0.05);完全性右束支传导阻滞病区组发生率17.4%,高于非病区组发生率7.9%(χ~2=4.323,P<0.05)。病区组与非病区组左室射血分数(LVEF)均值分别为30.49%、29.02%,二者比较差异无统计学意义(P>0.05)。病区组与非病区组左室短轴缩短率(LVFS)均值分别为15.17%、14.57%,二者比较差异无统计学意义(P>0.05)。扩张型心肌病合并传导阻滞组左室舒张末期内径(LVEDd)为(72.69±12.06)mm,高于非传导阻滞组(66.88±7.10)mm(t=3.976,P<0.01),扩张型心肌病合并室性早搏组LVEDd(70.16±9.48)mm高于无室性早搏组(66.76±10.01)mm(t=2.175,P<0.05)。不同年龄组间房颤发生率存在差异，年龄>55岁组扩张型心肌病患者房颤发生率为34.0%,均高于其他两个年龄段(χ~2=13.211,P<0.05)。相关性分析显示房颤的发生与年龄呈正相关(r=0.242,P<0.05)。结论 克山病病区内的扩张型心肌病患者应当引起克山病防治部门的重视与关注，在常规克山病监测工作中应加强病区内扩张型心肌病合并房颤或完全性右束支传导阻滞患者的鉴别诊断工作，将有利于减少病区克山病漏诊情况的发生。更多还原

【Abstract】 Objective To compare and analyze the clinical examination results of patients with dilated cardiomyopathy(DCM) in Keshan disease areas(KD areas) and non-KD areas, and to explore the difference of clinical manifestations of DCM in KD areas and non-KD areas, so as to provide a reference for the identification of key subjects in the screening of KD areas.Methods A retrospective survey was used to randomly select patients with DCM who were treated in the Department of Cardiology of the First Affiliated Hospital of Dali University from January 2021 to October 2022.The patients were divided into KD areas group and non-KD areas group according to their regular residence.Collected the clinical data of patients with DCM,and analyzed the clinical characteristics of two groups of patients, cardiac function and cardiac structural changes.Results A total of 210 patients with DCM,aged(55.1±11.8) years.There were 109 cases in KD areas group and 101 cases in non-KD areas group.All patients were classified as NYHA class Ⅱ or above, and 39.5% of them were in cardiac function class Ⅵ.The main manifestations of electrocardiogram abnormalities were atrial fibrillation, complete right bundle branch block, ventricular premature beat, conduction block and ST segment change.The incidence of atrial fibrillation in KD areas group was 29.4%,which was higher than that in non-KD areas group(χ~2=4.598,P<0.05).The incidence of complete right bundle branch block was 17.4% in KD areas group and 7.9% in the non-KD areas group(χ~2=4.323,P<0.05).The mean values of left ventricular ejection fraction(LVEF) in the KD areas and non-KD areas groups were 30.49% and 29.02%,respectively(P>0.05).The mean values of left ventricular fraction shortening(LVFS) in ward group and non-ward group were 15.17% and 14.57%,respectively(P>0.05).In DCM with atrial fibrillation group, left ventricular end diastolic diameter(LVEDd) was(72.69±12.06) mm, which was higher than that without atrial fibrillation(66.88±7.10) mm(t=3.976,P<0.01).DCM with ventricular premature beats(70.16±9.48) mm was higher than that without ventricular premature beats(66.76±10.01) mm(t=2.175,P<0.05).There were differences in the incidence of atrial fibrillation among different age groups.The incidence of atrial fibrillation in DCM patients older than 55 years was 34.0%,which was higher than the other two age groups(χ~2=13.211,P<0.05).Correlation analysis showed that the occurrence of atrial fibrillation was positively correlated with age(r=0.242,P<0.05).Conclusion The patients with DCM in KD areas should attract the attention and concern of Keshan disease prevention and control departments.In the routine Keshan disease surveillance, the differential diagnosis of DCM patients with atrial fibrillation or complete right bundle branch block should be strengthened, which is conducive to reducing the occurrence of KD missed diagnosis in KD areas.更多还原