成人急性重症心肌炎近期预后的相关因素和随访结果

Related factors in predicting prognosis in patients with acute fulminant myocarditis

目的分析影响成人急性重症心肌炎近期预后的相关因素及随访结果。方法入选2013年1月～2017年12月上海长海医院心内科收治的成人急性重症心肌炎患者52例与普通心肌炎患者20例。重症心肌炎患者按住院期间治疗结果分为生存组(44例)和死亡组(8例),回顾性对比分析患者的临床症状、实验室检查、治疗方式、急性并发症与治疗结果的关系;采用二元logistic回归(逐步法)分析重症心肌炎患者死亡的相关因素;重症心肌炎院内生存组44例患者与普通心肌炎组20例患者,出院后按队列研究随访0.5～5年,对比分析再住院率与扩张性心肌病的发病率。结果心电图QRS波时限延长、心源性休克发生率、血清肌酐、高敏肌钙蛋白I和脑钠尿肽值,死亡组显著高于生存组;二元logistic回归(逐步法)分析,血清肌酐、高敏肌钙蛋白I、脑钠尿肽值两组间有统计学差异;重症心肌炎组与普通心肌炎组患者出院后,两组在再住院率与扩张性心肌病的发病率上无显著差异。结论血清肌酐、高敏肌钙蛋白I、脑钠尿肽增高是重症心肌炎急性期预后不良的独立预测因素;急性重症心肌炎患者出院后远期预后较好。

AIM To analyze the related factors influencing the early prognosis and follow-up results in adult patients with acute fulminant myocarditis. METHODS The study included 52 adult patients with acute fulminant myocarditis and 20 adult patients with acute myocarditis in our hospital from January 2013 to December 2017. Fifty-two patients with acute fulminant myocarditis were divided into two groups according to results of treatment: survivor group (44 cases) and nonsurvivor group (8 cases). Data including clinical symptoms, laboratory examination, therapy method, and acute complications were compared between the two groups. The relationship between the data and the results of treatment was retrospectively analyzed. The related factors leading to death were analyzed by binary logistic regression (forward method). All patients in the survivor group (44 cases) and the acute myocarditis group (20 cases) were followed up for 0. 5 - 5 years and the re-hospitalization rate and morbidity of dilated cardiomyopathy ( DCM ) were compared. RESULTS Compared with those in the survival group, the incidence of QRS wave duration, cardiac shock, serum creatinine, troponin I ( cTnI) and B-type natriuretic peptide ( BNP) level significantly increased in the nonsurvivor group. Furthermore, binary logistic regression analysis suggested that serum creatinine, cTnI, and BNP level were independently correlated with the prognosis in patients with fulminant myocarditis. No significant differences were found in the re-hospitalization rate and the morbidity of DCM between the survival group and the nonsurvivor group. CONCLUTION Serum creatinine, cTnl, and BNP levels are independent predictors of poor prognosis. Overall, adult patients with acute fulminant myocarditis discharged from the hospital have good long-term prognosis.