病毒性心肌炎引起不同起源部位室性早搏儿童的预后比较及心肌灌注断层显像的临床价值

Comparison of prognosis in children with acute viral myocarditis induced ventricular premature beats originating from different positions and the clinical value of mgocardial perfusion ECT

摘要:

目的：探讨病毒性心肌炎引起不同起源部位的室性早搏儿童预后有无差异，并分析99mTC-MIBI心肌灌注断层显像（ECT）结果与患儿预后的关系。方法：回顾性分析83例病毒性心肌炎合并室性早搏患儿的病例，根据体表心电图表现，依据早搏起源部位分为右室流出道、右室前壁及心尖部、左室流出道和左室前壁及心尖部4组，均给予抗病毒、营养心肌药物治疗，比较4组近期及远期预后。并分析比较ECT结果与早搏预后的关系。结果：4种不同起源部位早搏相互之间的短期及长期有效率，差异均无统计学意义（P>0.05）。行ECT检查的40例患儿中，右室起源早搏与左室起源早搏的ECT阳性率差异无统计学意义（P>0.05）。ECT阳性患儿的治疗有效率高于ECT阴性患儿，差异有统计学意义（P<0.05）。结论：不同起源部位的室性早搏短期及长期预后无明显差异；病毒性心肌炎合并室性早搏患儿中，ECT阳性结果提示室性早搏预后较好。

Abstract:

OBJECTIVE: To study the difference in prognosis for children with acute viral myocarditis induced ventricular premature beats (VPB) originating from different positions, and to study the role of 99Mtc-MIBI myocardial perfusion ECT in the prognostic evaluation of VPB. METHODS: The clinical data of 83 children with viral myocarditis induced VPB were retrospectively studied. They were divided into four groups according to the original site of VPB, as shown by the ECG: right ventricular (RV) outflow tract, RV anterior wall and apex, left ventricular (LV) outflow tract, LV anterior wall and apex. All patients were treated with anti-viral drugs and myocardial nutritional medicine. Short-term and longterm outcomes in the four groups were compared. The relationship between the results of 99Mtc-MIBI myocardial perfusion ECT and prognosis in 40 patients was observed. RESULTS: There were no significant differences in short-term and long-term effective rates among the four groups (P>0.05). There were no differences in the ECT positive rates between the patients with VPB originating from RV and those with VPB originating from LV (P>0.05). The treatment effective rates of ECT-positive patients were higher than the treatment effective rates of ECT-negative ones (P<0.05). CONCLUSIONS: The short-term and long-term prognosis of children with VPB originating from different positions are not significantly different. In children with viral myocarditis induced VPB, positive ECT results suggest a better prognosis.