作者：郑小璞，马爱群，王锐，张炜

【关键词】  心肌病
　　Values of LDH and CKMB in evaluating the prognosis of idiopathic dilated cardiomyopathy
　　【Abstract】 AIM: To analyze the changes in concentrations of LDH, CKMB in 68 patients with idiopathic dilated cardiomyopathy (DCM) ,and the correlation between the concentrations of LDH, CKMB and the prognosis of DCM. METHODS:  LDH, CKMB were measured with continuous enzymelinked assay and immunosuppressive method respectively in following groups: the normal control group,  the duration of DCM<1year group and the duration of DCM1year group, the survival group and the death group. RESULTS:  The level of LDH was significantly higher in each group than that in the control group, especially in the duration of DCM≥1year group and the death group (P<0.05). The level of CKMB was significantly higher in the duration of DCM<1year group than that in the control group(P<0.05)，and was significantly reduced with the development of DCM, especially in the death group. COUCLUSION: The changes in concentrations of LDH, CKMB in patients with DCM appear to be associated with myocardial remodeling and the disturbance of energy metabolism. Persistently increased  concentration of LDH, gradually reduced  concentration of CKMB, and rapidly increased level of CKMB in a shortterm, all indicate the poor prognosis of the DCM patients.
　　【Keywords】cardiomyopathy, congestive; heart failure; myocardium/enzymology
　　【摘要】  目的：  观察68例扩张型心肌病心力衰竭患者LDH，CKMB在心力衰竭中的变化规律及其与预后的关系. 方法：  检测病程＜1 a组、病程1 a组、生存组及死亡组LDH，CKMB的变化. LDH采用酶连续法测定，CKMB采用免疫抑制法测定. 结果：  无论病程长短，LDH均高于对照组，随病程延长而增高，以死亡组为著；CKMB在病程＜1 a组，显著高于对照组，但随病程的延长反而明显降低，以死亡组为著. 结论：  扩张型心肌病心力衰竭患者LDH, CKMB变化可能与心室重构及心肌能量代谢障碍有关. LDH持续升高，CKMB随病程延长而下降，或短期内CKMB明显升高，均提示预后不良.
 
　　【关键词】  心肌病，充血性；心力衰竭；心肌/酶学
　　0引言
　　乳酸脱氢酶（LDH），心肌磷酸肌酶（CKMB）常被临床作为主要的心脏损伤标志，用来评价心肌损伤，并且认为血清酶浓度的高低代表了损伤的严重程度［1］. 近年研究发现许多疾病存在LDH，CKMB的变化，但慢性原发性心肌疾病变化规律以及与疾病发展的关系少见报道［2-3］，我们通过长期随访扩张型心肌病心力衰竭患者，观察其LDH，CKMB变化规律及其与疾病预后的关系，探讨慢性心力衰竭时LDH，CKMB变化的临床意义.
　　1对象和方法
　　1.1对象扩张型心肌病患者68(男41，女27)例，均为199502/200302住院患者. 年龄41.0±13.3（20～60）岁. 心功能分级（NYHA）Ⅲ级19例，Ⅳ级49例，心功能不全的病程8.7±6.1（1～15）a，平均随访年限4.8±2.6（1～8）a，年龄>50岁者，常规行冠脉造影排除冠心病、合并有严重感染及肝肾功能不全.
　　1.2方法
　　1.2.1分组将患者按心功能不全的病程以及随访的结果分为： 病程<1 a组（n=27），病程1a组(n=41);生存组（n=47）,死亡组(n=21)以及病程<1 a的死亡组（n=6）, 病程1a的死亡组(n=15). 对照组10例为与观察组年龄相匹配的健康献血员.
 
　　1.2.2LDH, CKMB的检测入院后常规给予地高辛、利尿剂、扩血管药等，病情稳定1 wk后于晨起抽空腹血3 mL，分

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