急性重症病毒性心肌炎的临床特征分析

Analysis of the Clinical Features of Acute Severe Viral Myocarditis

目的:探讨急性重症病毒性心肌炎的临床特征及心脏彩超和血清心肌损伤标志物对重症病毒性心肌炎的早期临床诊断价值。方法:回顾性分析2013年6月至2015年8月入住我院心脏科的临床诊断为急性心肌炎的患者27例,其中符合急性重症心肌炎诊断标准的患者10例,其余17例为非重症心肌炎,另选取10例入院检查后排除心血管疾病的患者为健康对照组。对三组患者的一般临床资料、心脏彩超结果及心肌损伤标志物结果进行分析,选取有统计学差异的指标行ROC曲线分析得出预测重症心肌炎的效能。结果:重症心肌炎组左室室间隔厚度、左室后壁厚度、左房内径、血浆B型尿钠肽较其余两组显著增高,进一步行ROC曲线分析提示左室室间隔厚度、左室后壁厚度预测重症心肌炎的敏感性分别为80%、70%,特异性均为94%,临界值分别为0.855 cm、0.875 cm。结论:急性心肌炎患者室壁厚度增加,当左室室间隔厚度>0.855 cm或左室后壁厚度>0.875 cm时需引起重视,警惕患者可能进展至重症病毒性心肌炎。

Objective： To explore the clinical features of acute severe viral myocarditis as well as the early diagnostic value of echocardiography and serum markers of myocardial injury on it. Methods： 27 patients who were in our department between June 2013 to August 2015 with acute myocarditis were enrolled in this study. Among which 10 were defined as the acute severe viral myocarditis while other 17 were defined as non-severe myocarditis. Another 10 health people were defined as the control group. The general clinical data, echocardiography index as well as the serum markers of myocardial injury were compared among the 3 groups. ROC curve analysis was used to evaluate the predictive efficacy of these index for severe myocarditis. Results： The interventricular septal thickness, left ventricular posterior wall thickness, left atrial size, type B urine sodium peptidewere significantly higher in the severe myocarditis group than the other two groups. ROC curve analysis indicated that the sensitivity of IVSTd and LVPWTd for the prediction of severe myocarditis was 80 % and 70 %, specificity was both 94 %, the cut-off value was 0.855 cm and 0.875 cm. Conclusions： The increasement of ventricular wall thickness, especially the IVSTd 〉0.855 cm or LVPWTd〉 0.875 cm implied the severity of patients with acute myocarditis.