急性重症病毒性心肌炎与急性心肌梗死的临床比较

Clinical comparison between acute myocardial infarction and acute severe viral myocarditis

目的探讨急性重症病毒性心肌炎与急性心肌梗死(AMI)在临床和心电学特征的异同。方法对10例急性重症病毒性心肌炎及24例急性心肌梗死患者的临床、心肌酶谱与心电学演变特征进行分析。结果重症病毒性心肌炎与急性心肌梗死的区别为:①常见于青壮年,发病前或发病时常有呼吸道、消化道感染史,且常伴发热,三度房室传导阻滞及阿-斯综合征发生率较高,而胸痛发生率低,相对较轻甚至无胸痛。②心肌酶谱升高相对不显著(一般呈轻～中度升高),尤其是CK-MB甚至可在正常范围,心肌酶峰不显著,CK峰值、CK-MB峰值及CK峰值/ST段抬高导联数比值、CK-MB峰值/ST段抬高导联数比值均明显低于急性心肌梗死组(P均<0.01)。③心电图损伤性改变显著,病理性Q波常呈一过性可逆性改变,多数呈QS或QR型,经适当治疗一般2～3天内消失;而急性心肌梗死组多数呈qR型,且病理性Q波逐渐增深、加宽、范围扩大或出现等电位性Q波。④ST段抬高和无对应性ST段压低。⑤病理性Q波与ST段抬高发生的导联“不吻合”,且不能用某支冠状动脉阻塞来解释心电图改变。结论急性重症病毒性心肌炎与急性心肌梗死可根据临床、心肌酶谱和心电学演变等特征,作出鉴别诊断。

Objective To investigate similarities and differences of clinical findings, myocardial enzymes and electrocardiogram between acute myocardial infarction （AMI） and acute severe viral myocarditis. Methods Data of lO cases with acute severe viral myocarditis and 24 cases with acute myocardial infarction were analyzed. Results By comparing to AMI, acute severe viral myocarditis had following features： ① Disease was usually seen in younger and associated with or following respiratory or digestive infection. Fever, third degree atrioventricular block and Adams-Stokes syndrome were main clinical findings.② Elevation of myocardial enzyme was usually mild or moderate. Peak value of CK-MB and ratio of it to number of lead with ST segment elevation was lower （P〈0.01）.③ Pathological Q wave appeared as QS or QR mostly rather than evolved from qR to QS and disappeared after 2-3 days treatment. ④ No reciprocal ST segment depression coexisted with ST segment elevation. ⑤Pathological Q wave and ST segment elevation did not occur in same lead. Condusion Acute severe viral myocardifis maybe distinguished from AMI by clinical manifestation, myocardial enzymes and electrocardiographic evolution.