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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c Tn I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。
Objective: To investigate the clinical features and prognosis of fulminant myocarditis in children. Methods: Retrospective analysis of the patient’s history, ECG, UCG, CMR, serological data and follow-up results obtained relevant risk factors affecting the prognosis. RESULTS: A total of 49 patients with fulminant myocarditis were treated, with an average age of 8.89 ± 3.63 years. 9 cases died (18.37%), the average survival time of 4 days, no late death. The first symptom of extracardiac performance accounted for 83.67%. The detection rates of serum CK-MB and cTnI abnormalities were 51.11% and 81.39% respectively at the time of first visit, and both were 47.50% at the same time. All 49 patients had obvious ECG abnormalities in the early stage of the disease. The incidence of ventricular arrhythmia was significantly different between the recovery group and the death group (P = 0.020). The incidences of decreased LVEF / LVFS in the recovery group and the death group were 62.5% and 100%, respectively (P = 0.157), and the mean recovery time to LVEF in the recovery group was 10.22 days. In the recovery group, 10 patients underwent CMR during the acute phase, of which 9 were consistent with Lake Louise. All patients were treated with high-dose hormones and gamma globulin. Eight patients had temporary cardiac pacemakers and four received ECOM treatment. Recovery group average follow-up 19.28 months, 100% clinical recovery. In multivariate survival analysis, the ultimate risk factor for death was age ≤ 6 years (RR 40.215, 95% CI 1.285-1258.369). Conclusion: Sudden onset of fulminant myocarditis, extracardiac symptoms as the first episode more common, timely diagnosis and treatment of patients is expected to fully recover. All patients have varying degrees of ECG abnormalities. Multivariate survival analysis found that age ≤ 6 years old was a risk factor for death.