成人急性病毒性心肌炎的临床表现与相关因素分析

Clinical Features and Related Factors Analysis in Adult Patients With Acute Virus Myocarditis

目的:探讨成人急性病毒性心肌炎的相关因素。方法:连续入选我院心内科2006年5月至2018年3月收治的成人急性病毒性心肌炎患者169例(发病1个月以内),根据临床诊断分为重症心肌炎组(n=49)和非重症心肌炎组(n=120)。比较两组患者入院时的症状、生命体征、心电图、实验室检查及超声心动图参数。通过二分类Logistic回归模型进行单因素及多因素分析。结果:重症心肌炎组患者来诊时血压较非重症心肌炎组患者更低、心率更快,发生持续性室性心动过速(室速)/心室颤动(室颤)、Ⅱ度/Ⅲ度房室阻滞的比例均高于非重症心肌炎组(P均<0.05)。多因素Logistic回归分析显示,心电图QRS间期延长(OR=1.027,95%CI:1.004~1.050,P=0.020)、入院时肌酸激酶同工酶(CK-MB)升高(OR=1.024,95%CI:1.002~1.047,P=0.031)、低游离T3(FT3)水平(OR=0.068,95%CI:0.016~0.287,P<0.01)及入院时左心室射血分数(LVEF)降低(OR=0.912,95%CI:0.854~0.975,P=0.007)是重症心肌炎的相关因素。结论:成人急性病毒性心肌炎患者出现心电图QRS间期延长、CK-MB升高、低FT3水平及入院时LVEF降低是重症心肌炎的相关因素。

Objectives: To observe the clinical features and determine the factors related to patients with acute virus myocarditis.Methods: The study population consisted of 169 consecutive patients admitted between May 2006 and March 2018 in our hospital with diagnoses of acute virus myocarditis(onset of symptoms <1 month), 49 were with life threatening arrhythmias, heart failure or cardiogenic shock(severe myocarditis group) and the remaining 120 were hemodynamically stable(non-severe myocarditis group). Clinical presentations, electrocardiography, laboratory tests, echocardiography features were analyzed.Results:Both of blood pressure and left ventricular ejection fraction(LVEF)(both of the P values<0.05) were significantly lower, while heart rate, prevalence of ventricular tachycardia or ventricular fibrillation as well as Ⅱ to Ⅲ degree atrioventricular block(all P values<0.05) were significantly higher in severe myocarditis group than in non-severe group.Multivariate logistic regression analysis revealed that prolonged QRS interval(OR=1.027, P=0.020), elevated creatine kinase isoenzyme MB type(CK-MB) level(OR=1.024, P=0.031), low serum free triiodothyronine(FT3) level(OR=0.068, P<0.01)and reduced left ventricular ejection fraction(LVEF) at admission(OR=0.912, P=0.007) were independent determinants associated with severe myocarditis.Conclusions: Prolonged QRS interval, elevated CK-MB, low serum FT3 and reduced LVEF at admission are independent determinants associated with acute severe myocarditis in adult patients with acute virus myocarditis.