儿童心肌炎危险分层和预后分析

Risk stratification and prognosis analysis of children with myocarditis

目的分析心脏磁共振成像(CMR)高危心肌炎儿童的临床特点、治疗和预后。方法选择首都医科大学附属北京安贞医院儿科自2018年1月至2019年7月收治的70例心肌炎儿童进行回顾性队列研究,CMR显示为心肌水肿和(或)晚期钆增强的患儿为CMR高危组(29例),CMR未见明显异常的患儿为CMR对照组(41例),比较两组心肌炎儿童的临床资料、治疗情况和随访时不良心血管事件发生率。Cox回归分析影响预后的危险因素。结果 70例心肌炎儿童中,男43例(61.4%),女27例(38.6%),平均年龄(7.6±5.3)岁(5~18岁)。两组的胸痛、乏力和胸闷等临床症状发生率差异无统计学意义(均P>0.05),但基础肌酸激酶-MB、心肌肌钙蛋白Ⅰ和左心室射血分数等差异均有统计学意义(均P<0.05),应用激素和卡托普利治疗的比例差异亦有统计学意义(均P<0.05)。平均随访3.7个月,17例患儿发生不良心血管事件,两组间不良心血管事件的发生率差异有统计学意义(31.0%vs. 19.5%,P<0.05)。Cox回归分析结果显示,高危CMR表现和心肌肌钙蛋白Ⅰ是影响不良心血管事件的危险因素。结论 CMR高危心肌炎儿童的临床表现虽多不典型,但病情重;虽加用激素和卡托普利等积极治疗,但短期随访时的不良心血管事件发生率仍较高,因此,需重视CMR高危心肌炎儿童的筛查、监护、治疗和随访。

ObjectiveTo evaluate the clinical and therapeutic characteristics and prognosis in high-risk children withmyocarditis assessed by cardiac magnetic resonance(CMR).MethodsA retrospective cohort study was performed in seventychildren with myocarditis,who were treated in Department of Pediatrics,Beijing Anzhen Hospital of Capital Medical Universityfrom January 2018 to July 2019. Children with the presence of myocardium edema and/or late gadolinium enhancement inCMR were in the high-risk CMR group(n=29)and those without CMR abnormalities were in the CMR control group(n=41). Clinical characteristics,treatment and rate of adverse cardiovascular events during the follow-up were compared betweenthe two groups. Cox regression analysis was used to evaluate the risk factor for prognosis.ResultsAmong the 70 children(aged 5 to 18 years,mean age 7.6±5.3),43 were male(61.4%)and 27 were female(38.6%). The incidences of chest pain,fatigue and chest distress were similar between the two groups(P>0.05). However,there were significant differences in thelevels of serum creatinine kinase MB,cardiac troponinⅠ,and left ventricular ejection fraction between the two groups(allP<0.05). Moreover,children in the high-risk CMR group were more likely to use the steroids and captopril(all P<0.05).After 3.7 months of follow-up,the rates of adverse cardiovascular events was significantly different between the two groups(31.3% vs. 19.5%,P<0.05). Cox regression analysis results showed that CMR high-risk images and cardiac troponinⅠ werethe risk factors for adverse cardiovascular events.ConclusionChildren with high-risk CMR images of myocarditis oftenhave no typical clinical demonstrations,but they are in a severe condition;although steroids and captopril were used for activetreatment,the incidence of adverse cardiovascular events is high in short-term follow-up. Therefore,early screening,monitoring,treatment and follow-up should be given greatattention in patients with high risk CMR images of myo-carditis.