摘要：

目的 探讨颅内动脉瘤性蛛网膜下隙出血并发Takotsubo 心肌病临床特点。方法 回顾分析14 例颅内动脉瘤性蛛网膜下隙出血并发Takotsubo 心肌病患者的临床资料、血清心肌酶谱［包括肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、氨基末端B 型利尿钠肽前体（NT-proBNP）］水平、心电图和超声心动图表现。结果 14 例患者入院时（初次检查）血清心肌酶谱［CK（591.93 ± 248.78）IU/L、CK-MB（27.07 ± 7.66）IU/L、NT-proBNP（8685.36 ± 3963.44）IU/L］水平即升高，2 周复查时下降［CK（137.79 ± 29.93）IU/L、CK-MB（14.36 ± 5.58）IU/L、NT-proBNP（577.14 ± 203.37）IU/L］，治疗前后差异具有统计学意义（t = 7.090，P = 0.000；t = 4.897，P = 0.000；t = 7.778，P = 0.000）。入院时心电图表现为ST 段抬高或压低、T 波倒置、QT 间期延长，超声心动图呈节段性左室壁运动异常，左心室射血分数（36.07 ± 6.15）%，2 周复查时升至（56.43 ± 3.18）%（t = 13.381，P = 0.000），1 个月后恢复正常。结论 颅内动脉瘤性蛛网膜下隙出血可诱发Takotsubo 心肌病，患病率约4.58%，患者预后良好。超声心动图对早期筛查至关重要，急性期可通过冠状动脉造影术明确诊断。

关键词: 颅内动脉瘤, 蛛网膜下腔出血, Takotsubo心肌病, 超声心动描记术

Abstract:

Objective  To investigate the clinical characteristics of Takotsubo cardiomyopathy (TTC) following intracranial aneurysmal subarachnoid hemorrhage (SAH).  Methods  Review all patients with intracranial aneurysmal SAH from January 2013 to January 2015 in our hospital, and finally a total of 14 patients who complicated TTC were selected. Their clinical data, creatine kinase (CK), creatine kinase isoenzyme MB (CK-MB), N-terminal pro-B-type natriuretic peptide (NT-proBNP), ECG and echocardiographic findings were analyzed.  Results  For 14 patients of TTC following aneurysmal SAH, the value of CK was (591.93 ± 248.78) IU/L in the first 24 h on admission, and significantly decreased to (137.79 ± 29.93) IU/L 2 weeks later (t = 7.090, P = 0.000); the value of CK-MB was (27.07 ± 7.66) IU/L in the first 24 h (3 cases were at normal levels), and significantly decreased to (14.36 ± 5.58) IU/L 2 weeks later (t = 4.897, P = 0.000); the value of NT-proBNP was (8685.36 ± 3963.44) IU/L in the first 24 h, and significantly decreased to (577.14 ± 203.37) IU/L 2 weeks later (t = 7.778, P = 0.000). ECG on admission mainly showed ST segment alternation, T wave inversion and QT interval prolongation. Echocardiograghic findings showed segmental left ventricular wall motion abnormalities. The average left ventricular ejection fraction (LVEF) was (36.07 ± 6.15)%, and increased to (56.43 ± 3.18)% 2 weeks later (t = 13.381, P = 0.000). The results of ECG and echocardiographic findings were normal after one month.  Conclusions  Intracranial aneurysmal SAH can lead to Takotsubo cardiomyopathy, the incidence of which is 4.58% approximately, and the prognosis is good. Echocardiographic findings are significantly important for early screening of Takotsubo cardiomyopathy, and coronary angiography (CAG) can be used to make a clear diagnosis in acute phase.

Key words: Intracranial aneurysm, Subarachnoid hemorrhage, Takotsubo cardiomyopathy, Echocardiography