目的 探讨儿童新发扩张型心肌病药物治疗后左心室逆重构的发生率及预测因素。方法 回顾分析2012 年2 月至2018 年11 月住院治疗的新发扩张型心肌病、心内膜弹力纤维增生症并随访至2020 年1 月或死亡的55 例患儿的临床资料，患儿住院及出院后均给予标准药物治疗。根据随访复查的超声心动图结果，定义随访时左心室射血分数（LVEF）较基线提高≥ 10%且LVEF≥ 55%，同时经体表面积标准化后的左心室舒张末期内径Z值（LVEDD-Z）较基线降低≥ 10% 且LVEDD-Z≤ 2 为达到左心室逆重构，调查左心室逆重构发生率。收集患儿首次入院时的临床和超声心动图等指标，采用多元logistic 回归方法分析左心室逆重构的基线预测指标。结果 55例患儿中，男16 例、女39 例，发病年龄中位数7 个月（范围23 天~ 13 岁2 个月）。超声心动图中位随访33 个月（范围1～85 个月）后，25 例患儿发生左室逆重构，其LVEF由入院时（37.1±7.4）%提高至随访时（65.7±5.4）%，LVEDD-Z由（9.5±3.0）降低至随访时的（1.3±0.6），差异均有统计学意义（P< 0 . 001）。单因素logistic 回归分析显示，肺动脉高压、中重度三尖瓣反流、血清白蛋白水平与儿童新发扩张型心肌病发生左室逆重构相关。多元logistic 回归分析显示，无中重度三尖瓣反流是儿童新发扩张型心肌病发生左室逆重构的独立预测因素（OR=9.75，95%CI ：1.03~87.62，P<0.05）。结论 近半数儿童新发扩张型心肌病经药物治疗后可发生左室逆重构，无中重度三尖瓣反流患儿发生左室逆重构的可能性大。

Objective To explore the prevalence and predictors of left ventricular reverse remodeling after drug therapy in children with new-onset dilated cardiomyopathy. Methods The clinical data of new-onset dilated cardiomyopathy and endocardial fibroelastosis were retrospectively analyzed in 55 children who were hospitalized from February 2012 to November 2018 and were followed up to January 2020 or death. The standard drug treatment was given to the children after hospitalization and discharge. Left ventricular inverse remodeling was defined as an increase in left ventricular ejection fraction (LVEF) by ≥ 10% from baseline and LVEF≥ 55 % during follow-up, and at the same time a decrease by ≥ 10% in left ventricular enddiastolic dimension z score (LVEDD-Z) after body surface area standardization from baseline and LVEDD-Z≤ 2 . The incidence of left ventricular inverse remodeling was investigated according to echocardiography results. The clinical and echocardiographic findings were collected at children's first admission. The baseline predictors of left ventricular reverse remodeling were analyzed by multivariate logistic regression. Results There were 55 children ( 16 males and 39 females) with a median age of 7 months (range: 23 days to 13 years and 2 months). After a median follow-up of 33 months (range 1 ~ 85 months), 25 children were found to have left ventricular reverse remodeling by echocardiography. The LVEF increased from ( 37 . 1 ±7 . 4 )% at admission to ( 65 . 7 ± 5 . 4 )% at follow-up, LVEDD-Z decreased from ( 9 . 5 ± 3 . 0 ) at admission to ( 1 . 3 ± 0 . 6 ) at follow-up, and the differences were statistically significant (P< 0 . 001 ). Univariate logistic regression analysis showed that pulmonary hypertension, moderate to severe tricuspid regurgitation and serum albumin level were associated with left ventricular reverse remodeling in new-onset dilated cardiomyopathy in children. Multivariate logistic regression analysis showed that neither moderate nor severe tricuspid regurgitation was an independent predictor of left ventricular reverse remodeling in recent-onset dilated cardiomyopathy in children (OR= 9 . 75 , 95 %CI: 1 . 03 ~ 87 . 62 , P< 0 . 05 ). Conclusions Nearly half of the children with recent-onset dilated cardiomyopathy can develop left ventricular remodeling after medical treatment, and children with moderate to severe tricuspid regurgitation are more likely to have left ventricular remodeling.