急性心肌炎患者院内不良事件的相关因素分析

Related factors analysis of in-hospital adverse events in patients with acute myocarditis

目的探讨急性心肌炎患者院内不良事件的相关因素。方法回顾性入选中国医学科学院阜外医院2006 年5 月至2019 年2 月收治的急性心肌炎患者231 例,以院内死亡或心脏移植作为院内复合不良事件,分为非不良事件组(n=213)和不良事件组(n=18),比较两组患者的临床表现及治疗情况,通过Logistic 回归模型进行单因素及多因素分析。结果不良事件组患者来诊时收缩压及左心室射血分数(left ventricular ejectionfraction, LVEF)较非不良事件组患者更低,肌酸激酶同工酶(creatine kinase isoenzyme-MB, CK-MB)浓度更高(P均<0.001),更多应用机械循环辅助[主动脉内球囊反搏(intra-aortic balloon pump, IABP)和体外膜肺氧合(extra?corporeal membrane oxygenation, ECMO)治疗]、糖皮质激素及免疫球蛋白治疗,差异均有统计学意义(P 均<0.001)。多因素Logistic 回归分析显示,入院时QRS 间期>120 ms(OR=6.666,P=0.014)、CK-MB>24 U/L(OR=18.914,P=0.010)、LVEF<40%(OR=6.597,P=0.016)是急性心肌炎患者院内不良事件的相关因素。结论急性心肌炎患者入院时QRS间期>120 ms、CK-MB>24 U/L及LVEF<40%是院内不良事件的相关因素。

Objectives To determine the factors related to the in-hospital adverse events in patients with acute myocar? ditis. Methods The study population consisted of 231 consecutive patients admitted between May 2006 and February 2019 with diagnoses of acute myocarditis in Fuwai Hospital. Composite adverse events were defined as in-hospital death or heart transplantation. Eighteen patients with acute myocarditis died or took heart transplantation (adverse events group), while 213 patients survived without heart transplantation (non-adverse events group). Clinical presentations and treatments were analyzed. Adverse events related factors were analyzed by Logistic regression analysis. Results Both of systolic blood pressure and left ventricular ejection fraction (LVEF) were significantly lower (P<0.001), while concen? tration of creatine kinase isoenzyme-MB (CK-MB) was higher (P<0.001) in adverse events group than in non-adverse events group. Patients with adverse events took treatment of mechanical circulatory support [intra-aortic balloon pump (IABP) and extracorporeal membrane oxygenation (ECMO)], glucocorticoid and intravenous immunoglobulins more than those with non-adverse events (P<0.001). Multivariate Logistic regression analysis revealed that QRS interval more than 120 ms (odd ratio=6.666, P=0.014), CK-MB higher than 24 U/L (odd ratio =18.914, P=0.010) and LVEF less than 40% at admission (odd ratio=6.597,P=0.016) were independent risk factors associated with adverse outcomes in patients with acute myocarditis. Conclusions QRS interval longer than 120 ms, CK-MB higher than 24 U/L and LVEF less than 40% at admission are independent risk factors associated with adverse in-hospital events in patients with acute myocarditis.