新型冠状病毒感染可能导致重症暴发性心肌炎研究进展

Advances in severe fulminant myocarditis caused by severe acute respiratory syndrome coronavirus 2 infection

新型冠状病毒肺炎目前在全球爆发,严重威胁着人类的健康和生命安全,其传染性强、传播速度快,防控和治疗难度大。多数患者主要表现为急性呼吸道感染症状,但也存在以心血管系统表现为首发症状的患者。重症暴发性心肌炎(FM)是心肌炎的一种特殊类型,其发病急骤,病情进展迅速,早期病死率高。FM的主要病因是病毒感染。目前,已有研究提示新型冠状病毒(SARS-CoV-2)可能造成心肌损害,多篇临床病例报道显示新型冠状病毒肺炎患者病程中伴发FM。因此,如何早发现、早干预、早治疗是决定患者预后的关键。尽管SARS-CoV-2导致心肌损害的确切病理生理机制尚未明确,但根据已有的诊疗实践经验以及既往对重症FM的认识,本文主要围绕SARS-CoV-2感染可能导致重症FM的流行病学、发病机制、临床表现、诊断及鉴别诊断、治疗手段等展开综述。

Corona virus disease-19 is a contagious,fast spreading and highly lethal disease,which is difficult to control and cure.Acute respiratory symptoms are the most common manifestations.Some patients also present cardiovascular injury as the initial symptom.Severe fulminant myocarditis(FM)is mostly caused by virus infection and characterized by acute onset,rapid progression and high mortality.Studies have reported that severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)can induce myocardial damage and confirmed the relation between SARS-CoV-2 infection and FM.Early detection,intervention and treatment of SARS-CoV-2 infection with FM become a critical issue in clinical practice.Physio-pathologic mechanism of SARS-CoV-2 induced myocardial damage is still under research.This article focuses on the epidemic features,pathogenesis,clinical manifestations,diagnosis and differential diagnosis,and treatment methods of SARS-CoV-2 induced severe FM based on clinical experience,previous knowledges and resent advances.