Objective To compare the differences and similarities between the diagnostic criteria of obstetrics and internal medicine in China with that of Hibbard for peripartum cardiomyopathy (PPCM).Methods From March 1995 to September 2009, a total of 49 patients were diagnosed as PPCM at the Peking University People's Hospital and the Fu Wai Hospital in Beijing, China. Obstetric diagnostic criteria was:PPCM was one of dilated cardiomyopathy,occurred during the third trimester of pregnancy through the 6th month postpartum,and without cardiovascular diseases before. Internal medicine diagnostic criteria was:PPCM was unexplained cardiomegaly and heart failure, occurred during the last month of pregnancy through the 5th month postpartum, and meet the echocardiographic criteria of dialated cardiomyopathy as follows:left ventricular end-diastolic dimension (LVEDd) greater than 5.0 cm; left ventricular ejection fraction (LVEF)less than 45% , and(or) left ventricular fractional shortening (LVFS) less than 30% ; or LVEDd greater than 2. 7 cm/body surface area (m2) ; or LVEDd > 117% of age and body surface area predictive value. Hibbard diagnostic criteria was: All four of the following: (1) heart failure within last month of pregnancy and 5 months postpartum; (2) absence of prior heart disease; (3) no determinable cause; (4) strict echocardiographic indication of left ventricular dysfunction; LVEF less than 45% , and/or LVFS less than 30% , and LVEDd greater than 2. 7 cm/m2. The compliance between obstetric and internal criteria with Hibbard criteria, and the reasons of incompliance between Chinese and international criteria were analyzed. Results Eight patients were diagnosed of PPCM by obstetricians according to Chinese obstetric criteria. Among them, 6 patients (6/8) did not meet Hibbard criteria. 2 of the six did not reach the time regulated in the criteria. All of the six had other determinable causes for heart failure, and their echocardiographic results did not meet the diagnostic standard either. The other 41 patients were diagnosed of PPCM by physicians according to Chinese internal medicine criteria. Among them, 7 patients (17%) did not meet Hibbard criteria, 3 of the seven did not reach the time regulated in the criteria, and had other determinable causes for heart failure either. 4 of the seven did not meet the echocardiographic standard part in the criteria. The Chinese internal medicine diagnostic criteria has a significant higher coincidence rate with Hibbard criteria, compared to Chinese obstetric criteria (83% vs. 25% ; P <0. 01). Among all 13 patients whose PPCM diagnosis did not meet Hibbard criteria, 5 cases did not reach the time regulated in the criteria, 9 cases had other determinable causes for heart failure, and 10 cases did not meet the echocardiographic standard part in the criteria. Preeclampsia was the most common determinable causes for heart failure, accounted for 7 cases. Conclusion There is obvious difference between Chinese and Hibbard diagnostic criteria for PPCM, especially Chinese obstetric criteria.%目的 探讨目前国内围产期心肌病诊断标准中产科标准及内科标准与国外Hibbard标准的符合情况及差异点.方法 1995年3月至2009年9月北京大学人民医院及中国医学科学院阜外心血管病医院住院的围产期心肌病患者49例.其中由北京大学人民医院产科按产科标准诊断的8例,内科按内科标准诊断的22例和由中国医学科学院阜外心血管病医院内科按内科标准诊断19例,按内科标准共诊断41例.(1)产科诊断标准:既往无心血管系统疾病史,于妊娠28周后至产后6个月内发生的扩张型心肌病即为围产期心肌病.(2)内科诊断标准:围产期心肌病是指发生于妊娠最后1个月或产后5个月内的不明原冈的心脏扩大和心功能衰竭,超声心动图诊断标准为:左心室舒张末期内径(LVEDd)>5.0 cm;左心室射血分数(LVEF)<45%和(或)左心室缩短分数(LVFS)<30%;或LVEDd>2.7 cnL/体表面积(m2);或LVEDd>年龄和体表面积预测值的117%.(3)Hibbard诊断标准:妊娠最后1个月至产后5个月内发生的心功能衰竭;既往无心脏病病史;无其他导致心功能衰竭的原凶;超声心动图标准为:LVEF<45%和(或)LVFS<30%;LVEDd>2.7 cm/m2;此4项标准必须全部符合才能诊断围产期心肌病.分析产科标准和内科标准诊断围产期心肌病与Hibbard标准的符合情况及不符合的原因.结果 (1)产科标准诊断围产期心肌病与Hibbard标准的符合情况:产科标准诊断的8例围产期心肌病患者中,不符合Hibbard标准有6例(6/8).其中,发病时间不符合2例,分别合并子痫前期和急性肾盂肾炎重度感染,可以成为导致心功能衰竭的原因;LVEF.均不符合超声心动图标准.另4例患者中,2例同时合并重度子痫前期和重度贫血,1例单纯合并子痫前期,1例单纯合并中度贫血,可以成为导致心功能衰竭的原因;同时该4例中LVEDd和LVEF均不符合标准者2例,LVEDd或LVEF不符合标准者各1例.(2)内科标准诊断围产期心肌病与Hibbard标准的符合情况:内科标准诊断的41例围产期心肌病患者中,不符合Hibbard标准者有7例(17%,7/41),与产科标准诊断的不符合率比较,差异有统计学意义(P<0.01).其中,发病时间不符合3例,均合并子痫前期,成为导致心功能衰竭的原因.另4例中LVEDd和INEF均不符合标准者1例,LVEF不符合标准者3例.(3)国内标准诊断围产期心肌病与Hibbard标准不符合的原因:国内标准诊断的49例围产期心肌病患者中共有13例不符合Hibbard标准,其中,发病时间不符合5例(10%,5/49),均为孕期发病患者;存在其他导致心功能衰竭的原因9例(18%,9/49),包括子痫前期5例、子痫前期合并贫血2例、贫血 1例、急性肾盂肾炎重度感染1例,均为孕期发病患者,合并子痫前期共7例(7/9);超声心动图检杏结果 不符合10例(20%,10/49).结论 与Hibbard标准相比,国内围产期心肌病诊断标准缺乏严格统一性;比较而言,内科标准有较好的符合性;而产科标准则有较大差异,成为导致产科诊断嗣产期心肌病符合率不高的主要原因;国内诊断围产期心肌病与Hibbard标准不符合的主要原因在于超声心动图检查结果 不达标.
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