小儿病毒性心肌炎与扩张型心肌病临床特征与鉴别

Clinical characteristics and difference of viral myocarditis and dilated cardiomyopathy in children

目的:探讨小儿病毒性心肌炎(VMC)与扩张型心肌病(DCM)的不同临床特征。方法:对63例小儿 VMC和23例小儿DCM的临床资料进行对比分析。结果:与VMC相比,DCM患儿发病年龄在2岁以下者 (4.3%)少见,病程较长(>2个月者占61.0%),心脏增大和心力衰竭发生率高(均P<0.05),心脏增大明显,中 重度二尖瓣反流(82.6%)多见,心力衰竭较严重,心脏收缩功能减退显著(P<0.05);与DCM相比,VMC患儿 多有新近病毒感染史(79.4%),血清病毒 IgM阳性(77.1%)及CK MB升高(77.8%)(均P<0.05),治疗3个月 后VMC患儿轻度增大的心脏恢复正常。结论:小儿VMC与DCM在发病年龄、病程、有无新近病毒感染史,CK MB升高、心脏增大、心力衰竭和心脏收缩功能减退的发生率及程度,治疗效应方面均有不同,但两者的差异是相 对的,必须综合判断才能做出正确诊断,其中超声心动图和治疗效应对鉴别诊断尤为重要。

Objective:To study clinically different characteristics between viral myocarditis (VMC)and dilated cardiomyopathy(DCM) in children. Method: The clinical differences between 63 children with viral myocarditis and 23 children with dilated cardiomyopathy were analyzed. Result:In 4.3% of children with DCM, the age of onset was less than 2 years. In 61.0% of children with DCM, the course was more than 2 months. Compared with VMC, children with DCM was younger and the course of DCM was longer(P< 0.05). The rate of cardiac enlargement and heart failure was higher in DCM than that in VMC(P< 0.05). The rate of regurgitation of mitral valve ranged from middle degree to severe degree ( 82.6%) was also higher in DCM than that in VMC. The cardiac enlargement and heart failure was more severe in DCM than that in VMC. The cardiac systolic function was more significantly decreased in DCM than that in VMC (P< 0.05). The course in 9.5% of children with VMC was more than 2 months,the course in VMC children was shorter compared with DCM. There was history of recent viral infection in 79.8% of children with VMC. The positive rate of viral IgM in serum was 77.1% in VMC. The level of CK-MB was increased in 77.8% of children with VMC. The rate of history of recent viral infection and increasing CK-MB was higher in VMC than that in DCM (P< 0.05). The positive rate of viral IgM in serum was also higher in VMC than that in DCM (P< 0.05).The slight heart enlargement in VMC recovered after treatment for 3 months. Conclusions:The clinical difference between VMC and DCM in children is relative though there are some differences between DCM and VMC in age of onset ,course of disease, history of recent viral infection ,rate and level of increasing CK-MB,incidence and degree of cardiac enlargement,heart failure,reduction of cardiac systolic function and reaction to treatment . General judgement must be made in order to take correct diagnosis. In those factors mentioned above ,echocardiography and responge to treatment are specially important in differential diagnosis.