19例儿童重症心肌炎诊治体会

Experience of diagnosis and treatment of 19 cases with acute severe viral myocarditis in children

目的 探讨儿童重症心肌炎临床特点及治疗方法。方法 对我院2005年1月至2012年1月收治的19例儿童重症心肌炎（重症心肌炎组）发病特点、临床表现、诊治经过及预后进行回顾性分析,选择同期在我院体检的正常健康儿童23例为对照组。采用ELISA法检测心肌肌钙蛋白（cardiac troponin,CTn）-Ⅰ及血清氨基末端脑利钠肽前体（N-terminal pro-brain natriuretic peptide,NT-proBNP）水平,应用彩色多普勒超声心动图检查了解左室射血分数和左室短轴缩短率变化。结果 重症心肌炎组患儿CTn-Ⅰ为（18.67 ±12.31） ng/ml,显著高于正常对照组[（0.02 ±0.01） ng/ml],差异有统计学意义（P＜0.05）。与急性期相比,病程第7天CTn-Ⅰ为（0.55±0.24） ng/ml,呈逐渐下降趋势,第14天基本接近正常[（0.06±0.03） ng/ml],差异有统计学意义（P＜0.05）。重症心肌炎组NT-proBNP较对照组明显增高[（3 067.26 ±902.79） pg/ml vs （80.04±17.79） pg/ml,P＜0.05]。与急性期相比,病程第7天NT-proBNP为（648.63±342.37） pg/ml,病程第14天基本接近正常[（213.58±129.51） pg/ml]（P＜0.05）。重症心肌炎组患儿左室射血分数[（52.63±6.98）％vs（71.39±2.41）％]及左室短轴缩短率[（32.1±2.97）％vs（40.04±2.31）％]明显低于正常对照组,差异均有统计学意义（P均＜0.05）。结论 儿童重症心肌炎起病急,病情重,病死率高,在综合治疗基础上早期应用肾上腺素皮质激素和丙种球蛋白,必要时安装临时起搏器,可改善预后。

Objective To explore the clinical features and treatment of children with acute severe viral myocarditis.Methods The clinical data of presentation,diagnosis,therapy and prognosis of children who were admitted in our hospital from Jan 2005 to Jan 2012 with acute severe viral myocarditis（severe myocarditis group） were analyzed retrospectively.Twenty-three cases of normal healthy children in the same period were selected as control group.The levels of serum cardiac troponin（CTn）-Ⅰ and N-terminal pro-brain natriuretic peptide（NT-proBNP） were detected by ELISA method,the changes of left ventricular ejection fraction and left ventricular fraction shortening were understood by color doppler echocardiography.Results The level of CTn-Ⅰin severe myocarditis group was significantly higher than that of control group,the difference was statistically significant [（18.67 ± 12.31） ng/ml vs （0.02 ±0.01） ng/ml,P ＜0.05].Compared with the acute phase,the level of CTn-Ⅰshowed a trend of gradual decline in 7 d [（0.55 ±0.24） ng/ml],basic close to normal in 14 d [（0.06 ±0.03） ng/ml] （P ＜0.05）.The level of NT-proBNP increased significantly in severe myocarditis group compared with control group [（3 067.26 ± 902.79） pg/ml vs （80.04 ± 17.79） pg/ml,P ＜0.05].Compared with acute phase,the levels of NT-proBNP were closed to normal in 7 d [（648.63 ±342.37） pg/ml] and 14 d [（213.58 ± 129.51） pg/ml] （P ＜ 0.05）.The left ventricular ejection fraction [（52.63 ± 6.98） ％ vs （71.39 ± 2.41） ％] and left ventricular fraction shortening [（32.1 ± 2.97） ％ vs （40.04 ± 2.31） ％] in severe myocarditis group were significantly lower than those in control group （P ＜ 0.05）.Conclusion Acute severe viral myocarditis of children was characterized by rapid onset,severe illness and high mortality.Early use of adrenal cortical hormone and gamma globulin under the comprehensive treatment and application temporary pacemaker can help patients to recover from the disease.