小儿暴发性心肌炎危险因素分析

Risk factors for acute fulminant myocarditis in children

摘要:

目的：通过对小儿病毒性心肌炎临床表现、体征以及实验室检查指标等方面进行回顾性分析研究，以探讨小儿暴发性心肌炎的危险因素。方法：收集临床诊断为病毒性心肌炎患儿资料71例，分为暴发性心肌炎组(n=16)和非暴发性心肌炎组(n=55)，采用χ2检验或t检验对两组患儿入院时的临床表现、心电图、心脏B超与血清生化检查等各项指标进行回顾性分析，对有统计学意义的相关因素，进行logistic多元回归分析，研究暴发性心肌炎的独立高危因素。结果：暴发性心肌炎组死亡率远高于非暴发性心肌炎组（50% vs 0%）。急性病毒性心肌炎患儿入院时血压降低、血清CK-MB水平升高、cTnI阳性、心电图QRS波时限延长、ST段改变、完全性房室传导阻滞、完全性左束支传导阻滞，以及左室射血分数和左室短轴缩短率降低与心肌炎暴发阶段密切相关。QRS波群时限延长（OR＝1.139;CI＝1.014~1.279; P<0.05）和左心室射血分数降低（OR＝0.711;CI＝0.533~0.949;P<0.05）是小儿暴发性心肌炎的独立阳性预测因素。结论：暴发性心肌炎死亡率高。入院时QRS波群时限延长和左心室射血分数降低是小儿暴发性心肌炎的独立危险因素。［中国当代儿科杂志，2009，11（8）：627-630］

Abstract:

OBJECTIVE: To investigate the risk factors for fulminant myocarditis by analyzing clinical symptoms/signs or laboratory findings in children with viral myocarditis. METHODS: The medical data of 71 children with acute viral myocarditis from March 2005 to September 2008 were retrospectively studied. They were classified into fulminant (n=16) and non-fulminant myocarditis groups (n=55). Chi-square and Student's t-test were used to analyze the clinical presentations, laboratory data, EEG and cardiac ultrasound findings on admission. The multiple regression analysis was used to identify the independent risk factors for fulminant myocarditis. RESULTS: Eight children (50%) died in the fulminant myocarditis group, but none in the non-fulminant group. The following factors were closely related to the fulminant course of myocarditis: lower blood pressure, higher serum CK-MB level, positive cTnI, complete atrioventricular block and left bundle branch block, ST segment alterations, prolonged QRS complex, and decreased left ventricular ejection fraction and short axis fractional shortening. Multiple regression analysis revealed that prolonged QRS complex (OR=1.139; CI=1.014-1.279, P<0.05) and decreased left ventricular ejection fraction (OR= 0.711; CI=0.533-0.949, P<0.05) were independent risk factors for fulminant myocarditis. CONCLUSIONS: The mortality of fulminant myocarditis is high in children. Prolonged QRS complex and decreased left ventricular ejection fraction on admission are independent risk factors for fulminant myocarditisin in children.［Chin J Contemp Pediatr, 2009, 11 (8):627-630］