登革热并发病毒性心肌炎138例

138 cases of dengue fever complicated with viral myocarditis

目的探讨登革热合并病毒性心肌炎的临床特点,提高对该病的诊治水平。方法对广州市第八人民医院2014年收治的138例登革热合并病毒性心肌炎患者的临床和辅助检查资料进行分析。结果 138例患者中男79例,女59例,平均年龄(60.01±21.54)岁,有基础病者87例,包括高血压34例(39.1%)、糖尿病14例(16.1%)、脂肪肝17例(19.5%)、脑梗塞9例(10.3%)和慢性病毒性肝炎13例(14.9%)。出现心肌炎临床症状者53例(38.4%),心肌酶谱异常者87例(63.0%),心电图异常者111例(80.4%),心脏彩超异常者53例(38.4%)。138例患者中,并发心功能不全者9例(6.5%),并发心源性休克2例(1.4%)。129例(93.5%)患者好转或治愈出院,9例未愈或死亡(6.5%),其中1例死于严重心律失常,1例死于心力衰竭。结论急性病毒性心肌炎是登革热的常见并发症之一,多发生于有基础病的老年人。临床表现多数为轻度心肌损伤,少数病例可发生严重心律失常或心力衰竭而死亡。

Objective To investigate the clinical characteristics of dengue fever complicated with viral myocarditis,and improve the level of diagnosis and treatment of the disease. Methods The clinical data of 138 cases of dengue fever complicated with acute myocarditis admitted in our hospital in 2014 were investigated retrospectively. Results Among the138 cases,79 cases were male and 59 cases were female.The average age was（60.01±21.54）years. 87 cases had underlying diseases,including hypertension 34 cases（39.1%）,diabetes mellitus 14 cases（16.1%）,fatty liver 17 cases（19.5%）,cerebral infarction 9 cases（10.3%）and chronic viral hepatitis 13 cases（14.9%）. There were 53 cases（38.4%）with myocarditis,87 cases（63.0%）with abnormal myocardial enzyme,111 cases（80.4%）with abnormal electrocardiogram,and53 cases（38.4%）with abnormal ultrasonic cardiogram. Of the 138 patients,9 cases（6.5%）were complicated by cardiac insufficiency and 2 cases（1.4%）were complicated by cardiac shock. 129 patients（93.5%）were cured and discharged from hospital;1 patients died of ventricular arrhythmia and 1 patients died of cardiac failure. Conclusions Acute viral myocarditis is one of the common complications of dengue fever. It is more common in the elderly with basic diseases. Most of the patients showed mild myocardial injury,a few cases died of severe arrhythmia or cardiac failure.