| 刘晓婷,黄美容,郭 颖,傅立军,刘廷亮,高 伟,李 奋,陈树宝.49例儿童暴发性心肌炎的临床特点与预后[J].,2017,17(1):51-54 |
| 49例儿童暴发性心肌炎的临床特点与预后 |
| Clinical Characteristics and Prognosis of 49 Children with Fulminant Myocarditis |
| 投稿时间：2016-05-09 修订日期：2016-05-28 |
| DOI：10.13241/j.cnki.pmb.2017.01.012 |
| 中文关键词: 暴发性心肌炎 预后 儿童 |
| 英文关键词: Fulminant myocarditis Prognosis Child |
| 基金项目:上海市科委产学研医项目(12DZ1940205)；上海交通大学医工交叉项目(YG2013MS05) |
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| 中文摘要: |
| 摘要 目的：探讨儿童暴发性心肌炎的临床特点及与预后的关系。方法：回顾性分析患者病史、ECG、UCG、CMR、血清学检查资料及随访结果，得出影响预后的相关危险因素。结果：共收治49例暴发性心肌炎患者，平均年龄8.89±3.63岁。死亡9例（18.37%)，平均存活时间4天，无晚期死亡。以心外表现为首发症状者占83.67%。初诊时血清CK-MB及cTnI异常检出率分别为51.11%和81.39%，两者同时增高占47.50%。49例患者在疾病初期均存在明显的心电图异常，其中室性心律失常的发生率在恢复组与死亡组间存在明显差异（P=0.020）。恢复组与死亡组LVEF/LVFS降低的发生率分别为62.5%和100%（P=0.157），恢复组LVEF恢复正常平均时间10.22天。恢复组中10例患者在急性期行CMR检查，其中9例符合路易斯湖。所有患者均使用大剂量激素及丙种球蛋白治疗。8例患者安装临时心脏起搏器，4例接受ECOM治疗。恢复组平均随访19.28月，100%临床痊愈。多因素生存分析，最终与死亡有关的危险因素为年龄≤6岁（RR40.215,95%CI（1.285-1258.369））。结论：暴发性心肌炎起病急骤，以心外症状为首发者多见，经及时诊断、治疗的患者有望完全康复。所有患者均存在不同程度心电图异常。多因素生存分析发现年龄≤6岁为死亡的危险因素。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the clinical characteristics and outcomes predictors of fulminant myocarditis. Methods: The clin- ical finding and follow-up data, including medical history, ECG, UCG, CMR, serological examination were analyzed to get outcomes predictors of fulminant myocarditis. Results: 49 fulminant myocarditis patients were analyzed. The average age of 49 patients was 8.89±3.63 years. Dead patients were 9 cases (18.37%) and the average survival time was 4 days, no late death. First symptom that outside the heart performance accounted for 83.67%. With serum CK-MB detection, the abnormal detection rate is 51.11%. With serum cTnI detec- tion, the abnormal detection rate is 81.39%. Both abnormalities accounted for 47.50%. 49 patients in the early stages of the disease have obvious abnormal ECG. The incidence of ventricular arrhythmia was significantly different between the recovery group and the death group (P=0.020). The incidence of LVEF/LVFS reduction in the recovery group and death group was respectively 62.5% and 100% (P=0.157), and the LVEF recovered to normal average time of recovery group was 10.22 days. In the recovery group, 10 patients were exam- ined by CMR in the acute phase,and 9 patients accorded with Lake Louise Consensus Criteria. In the recovery period. All the patients were given large doses of steroids and immunoglobulin. 8 cases were treated with temporary cardiac pacing, and 4 cases were treated with ECOM. The recovery group was followed up for 19.28 months, and all patients recured. By multivariate survival analysis, age ≤6 years (RR40.215, 95%CI (1.285-1258.369) was the final risk factors associated with death. Conclusion: Fulminant myocarditis attacks abruptly, and the heart outside symptom is often the first to see. After timely diagnosis and treatment, patients are expected to make a full recovery. All patients had different degrees of abnormal ECG. Age ≤6 years was the final risk factors associated with death. |
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