儿童暴发性心肌炎危险因素分析

Analysis of risk factors for fulminant myocarditis in children

目的探讨儿童暴发性心肌炎的危险因素。方法回顾性分析我院2015年1月至2018年12月临床诊断为病毒性心肌炎的67例患儿的临床资料,分为暴发性心肌炎组(n=13)及普通心肌炎组(n=54),比较两组患儿的性别、年龄、前驱感染史、临床表现、实验室检查、心电图、超声心动图、影像学表现等,对两组差异有统计学意义的相关因素进行Logistic回归分析,研究暴发性心肌炎的独立危险因素。结果(1)暴发性心肌炎组7例死亡,其中4例入院后24 h内死亡,普通心肌炎组无死亡病例。(2)暴发性心肌炎组面色发绀、腹胀、抽搐、肢端发凉的发生率均高于普通心肌炎组(P<0.05)。(3)暴发性心肌炎组肌酸激酶同工酶、乳酸脱氢酶、α-羟丁酸脱氢酶、天冬氨酸转氨酶均高于普通心肌炎组,差异有统计学意义(P<0.05)。(4)暴发性心肌炎组心电图QRS波时程较普通心肌炎组延长[118(82,127)ms比62(62,122)ms],差异有统计学意义(P<0.05)。暴发性心肌炎组室性心动过速的发生率高于普通心肌炎组(P<0.05)。(5)暴发性心肌炎组超声心动图左室射血分数(LVEF)降低、左室短轴缩短率(LVFS)降低、左心室扩大的发生率高于普通心肌炎组[92.3%(12/13)比18.5%(10/54),84.6%(11/13)比9.3%(5/54),76.9%(10/13)比13.0%(7/54)],差异有统计学意义(P<0.05)。暴发性心肌炎组胸部X线检查发现心影扩大、肺瘀血的发生率均高于普通心肌炎组(P<0.05)。(6)Logistic回归分析显示LVEF降低(OR=19.015,95%CI 1.456~248.348,P=0.025)、LVFS降低(OR=18.691,95%CI 2.062~169.453,P=0.009)、QRS波时程延长(OR=1.040,95%CI 1.001~1.082,P=0.046)是发生暴发性心肌炎的独立危险因素。结论儿童暴发性心肌炎早期病死率高,LVEF降低、LVFS降低、QRS波时程延长是儿童发生暴发性心肌炎的独立危险因素。

Objective To investigate the risk factors of fulminant myocarditis in children.Methods The clinical data of 67 children with clinical diagnosis of viral myocarditis from January 2015 to December 2018 in our hospital were retrospectively analyzed.The children were divided into fulminant myocarditis group(n=13)and common myocarditis group(n=54).The clinical data of gender,age,history of pre-infection,clinical manifestations,laboratory tests,electrocardiogram,echocardiography,and imaging findings were compared between the two groups.The multiple Logistic regression analysis was used to identify the independent risk factors of fulminant myocarditis.Results(1)Seven cases(53.8%)died in the fulminant myocarditis group,4 cases(30.8%)of them died within 24 hours after admission,and all the children in the common myocarditis group improved and discharged.(2)The incidences of facial cyanosis,abdominal distension,convulsions,and chills were higher in the fulminant myocarditis group than those in the common myocarditis group(P<0.05).(3)The level of creatinekinase-MB,lactate dehydrogenase,α-hydroxybutyric dehydrogenase and aspartate transferase in the fulminant myocarditis group were higher than those in the common myocarditis group(P<0.05).(4)On electrocardiogram,QRS wave duration in the fulminant myocarditis group was longer than that in the common myocarditis group[118(82,127)ms vs.62(62,122)ms,P<0.05].The incidences of ventricular tachycardia in the fulminant myocarditis group was higher than that in the common myocarditis group(P<0.05).(5)In the fulminant myocarditis group,the incidences of left ventricular ejection fraction(LVEF)decreased,the left ventricular short axis fraction shortening(LVFS),and the incidence of left ventricular enlargement were higher than those in the common myocarditis group[92.3%(12/13)vs.18.5%(10/54),84.6%(11/13)vs.9.3%(5/54),76.9%(10/13)vs.13.0%(7/54),P<0.05].Chest X-ray examination of the fulminant myocarditis group showed that the incidences of heart shadow enlargement and pulmonary blood stasis were higher than those in the common myocarditis group(P<0.05).(6)Multiple Logistic regression analysis revealed that LVEF reduction(OR=19.015,95%CI 1.456-248.348,P=0.025),LVFS reduction(OR=18.691,95%CI 2.062-169.453,P=0.009)and prolonged QRS wave duration(OR=1.040,95%CI 1.001-1.082,P=0.046)were independent risk factors for fulminant myocarditis.Conclusion The early mortality of fulminant myocarditis is high in children,and the LVEF reduction,LVFS reduction and prolonged QRS wave duration are independent risk factors for fulminant myocarditis.