柯萨奇B族病毒感染致急性病毒性心肌炎的临床分析

Analysis of the acute viral myocarditis caused by Coxsackievirus B

目的分析柯萨奇B族病毒（CBV）感染所致病毒性心肌炎（VMC）急性发作的临床特点,为其临床分段治疗提供参考。方法选取2013年1-12月96例急性病毒性心肌炎患者为观察组,进行CBV病毒标志物测定,并与对照组100名健康体检者进行对比,观察CBV在急性病毒性心肌炎中发生情况,并根据是否CBV感染将患者分为CBV感染49例及非CBV感染47例,对比CBV感染与非感染患者临床症状、体征、实验室检查结果等,分析柯萨奇B族病毒感染所致急性病毒性心肌炎的临床特点。结果观察组患者CBV感染阳性率51.0%,高于对照组的13.0%,其中CBV2～5型病毒感染阳性率高于对照组;观察组CBV感染患者在多项临床症状分布高于非CBV感染患者,症状改善时间长于非CBV感染,室性早搏、窦速、ST-T异常、房室传导阻滞等分布高于非CBV感染患者,房性早搏分布低于非CBV感染患者,肌酸激酶（CK）及肌酸激酶同工酶（CK-MB）水平均高于非CBV感染患者,差异有统计学意义（P〈0.05）。结论柯萨奇B族病毒感染在急性病毒性心肌炎中感染率较高,其急性发作突出表现为临床症状较多,体征消失较慢,实验室检查特别是CBV病毒标志物检查及心肌酶谱检查、心电图检查能够较好的进行鉴别,在发作前期给予抗病毒感染能够较快改善患者临床症状,提高患者的生活质量。

OBJECTIVE To observe and analyze the clinical features of acute viral myocarditis （VMC） caused by Coxsackie B so as to provide references for clinical treatments in different phases .METHODS Totally 96 cases of patients with acute viral myocarditis from Jan .to Dec .2013 were chosen as observation group and were detected by CBV marker .They were compared with the control group with 100 healthy people .The status of CBV was ob‐served .Patients were divided into infection group with 49 cases and non‐infection group with 47 cases .Their clini‐cal symptoms ,signs and lab inspection results were compared so that the clinical features of Coxsackievirus B can be analyzed accordingly .RESULTS The positive rate of total CBV infection was 51 .0% in observation group , which was higher than that of the control group with 13 .0% .The CBV2 ~ 5 infection rate in observation group was higher than the control group too .CBV infected patients in the observation group had multiple clinical symp‐toms than the patients without CBV infection .They also recovered more slowly than those not infected .Symp‐toms like VPB ,sinus ,abnormal ST‐T and atrioventricular block occurred more frequently in those infected with CBV ,while atrial premature beats appeared more often in patients without CBV infection .CK level and CK‐MB level was higher in patients infected by CBV .The differences were significant （P〈0 .05） .CONCLUSION Coxsack‐ievirus B is common in patients with acute viral myocarditis .If infected ,patients will manifest as multiple clinical symptoms and slowly disappeared signs .Lab inspection ,especially CBV marker test ,myocardial enzyme examina‐tion and ECG can be used for a better identification .Antiviral treatment before VMC attacks can improve clinical symptoms in a quick way and enhance the patients′life quality .