肾综合征出血热合并病毒性心肌炎心脏损害患者动态心电图变化探究

Ambulatory electrocardiogram changes in patients with hemorrhagic fever with renal syndrome complicated with viral myocarditis

目的探究不同临床分期肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)合并病毒性心肌炎(viral myocarditis,VM)心脏损害患者动态心电图变化特点,为HFRS合并VM的临床诊治提供参考。方法选取本院2013年12月至2016年12月收治的127例HFRS患者为研究对象,将合并VM者纳入观察组(43例),未合并VM者纳入对照组(84例),比较两组患者各临床分期心肌酶水平,观察动态心电图异常情况(以出现期前收缩、传导阻滞、T波改变、ST-T改变等为异常心电图表现)。结果在发热期和低血压期,两组患者乳酸脱氢酶(lactic acid dehydrogenase,LDH)、α-羟丁酸脱氢酶(α-hydroxybutyrate dehydrogenase,α-HBD)、天冬氨酸转氨酶(aspartate aminotransferase,AST)、肌酸激酶(creatine kinase,CK)水平均高于多尿期和恢复期(P<0.05);在发热期、低血压期、多尿期及恢复期,两组患者肌酸激酶同工酶MB(CK-MB)水平均低于少尿期(P<0.05)。观察组患者各临床分期LDH、α-HBD、CK、CK-MB水平均高于对照组(P<0.05)。在发热期、低血压期、少尿期及恢复期,观察组患者动态心电图异常总发生率均显著高于对照组(P<0.05)。结论 HFRS合并VM心脏损害患者以心肌酶水平显著升高为主要表现,并伴有期前收缩、传导阻滞等动态心电图明显异常表现,可据此评估患者是否发生VM心脏损害及心肌损伤严重程度,从而指导心肌保护、纠正心律失常等治疗策略的合理制订。

Objective To investigate ambulatory electrocardiogram characteristics of heart damage in different clinical stages patients with hemorrhagic fever with renal syndrome(HFRS)complicated with viral myocarditis(VM),to provide the reference for clinical diagnosis and treatment of HFRS complicated with VM.Method127patients with HFRS in our hospital from December2013to December2016were selected,patients complicated with VM were included into observation group(n=43),patients didn't complicated with VM were included into control group(n=84).The myocardial enzyme level and ambulatory electrocardiogram abnormalities(extrasystole,conduction block,T wave or ST-T change)in the two groups were compared.Result The levels of lactic acid dehydrogenase(LDH),α-hydroxybutyrate dehydrogenase(α-HBD),aspartate aminotransferase(AST),creatine kinase(CK)of the two groups in febrile stage and hypotension stage were higher than those of polyuria stage and convalescent stage(P<0.05),and the level of creatine kinase isoenzyme(CK-MB)in febrile stage,hypotension stage,diuresis stage and convalescent stage of the two groups were lower than those of oliguric stage(P<0.05);the levels of LDH,α-HBD,CK and CK-MB of observational group in different clinical stages were higher than those of control group(P<0.05).The total incidence of abnormal electrocardiogram of observation group in febrile period,hypotension period,oliguric period and convalescent period were higher than those of control group(P<0.05).Conclusion Myocardial enzyme spectrum is the main clinical feature in the patients with HFRS complicated with VM cardiac damage,and it is associated with the incidence of abnormal electrocardiogram such as premature beat,conduction block,T wave and ST-T change,which can be used to evaluate if there is heart damage and the severity of myocardial injury.This can guide the therapeutic regimen including myocardial protection and arrhythmia correction.