Sliwa Karen, Fett James, Elkayam Uri
Soweto Cardiovascular Research Unit, Department of Cardiology, Chris-Hani-Baragwanath Hospital, University of the Witwatersrand, P O Bertsham 2013, Johannesburg, South Africa.
Lancet. 2006 Aug 19;368(9536):687-93. doi: 10.1016/S0140-6736(06)69253-2.
Peripartum cardiomyopathy (PPCM) is a disorder in which initial left ventricular systolic dysfunction and symptoms of heart failure occur between the late stages of pregnancy and the early postpartum period. It is common in some countries and rare in others. The causes and pathogenesis are poorly understood. Molecular markers of an inflammatory process are found in most patients. Clinical presentation includes usual signs and symptoms of heart failure, and unusual presentations relating to thromboembolism. Clinicians should consider PPCM in any peripartum patient with unexplained disease. Conventional heart failure treatment includes use of diuretics, beta blockers, and angiotensin-converting enzyme inhibitors. Effective treatment reduces mortality rates and increases the number of women who fully recover left ventricular systolic function. Outcomes for subsequent pregnancy after PPCM are better in women who have first fully recovered heart function. Areas for future research include immune system dysfunction, the role of viruses, non-conventional treatments such as immunosuppression, immunoadsorption, apheresis, antiviral treatment, suppression of proinflammatory cytokines, and strategies for control and prevention.
围产期心肌病（PPCM）是一种在妊娠晚期至产后早期出现初始左心室收缩功能障碍和心力衰竭症状的疾病。在一些国家较为常见，而在其他国家则较为罕见。其病因和发病机制尚不清楚。大多数患者体内可发现炎症过程的分子标志物。临床表现包括心力衰竭的常见体征和症状，以及与血栓栓塞相关的不寻常表现。临床医生应考虑任何患有不明原因疾病的围产期患者是否患有PPCM。传统的心力衰竭治疗包括使用利尿剂、β受体阻滞剂和血管紧张素转换酶抑制剂。有效的治疗可降低死亡率，并增加左心室收缩功能完全恢复的女性人数。PPCM后首次完全恢复心脏功能的女性，其后续妊娠的结局更好。未来的研究领域包括免疫系统功能障碍、病毒的作用、免疫抑制、免疫吸附、血液分离术、抗病毒治疗、促炎细胞因子抑制等非常规治疗方法，以及控制和预防策略。
