儿童暴发性心肌炎12例临床分析

Clinical analysis of fulminant myocarditis in 12 children

目的分析儿童暴发性心肌炎(FM)的临床特点,为儿科医师临床决策提供参考。方法回顾性分析2019年10月至2022年10月在儿科重症监护病房(PICU)住院治疗的FM患儿临床资料。结果纳入FM患儿12例,男5例、女7例,中位年龄10.0(5.6~12.6)岁,起病至就诊中位时间5.0(3.0~6.0)天,中位住院时间12.0(11.0~16.8)天。12例患儿就诊时症状无特异性,11例合并循环系统症状,1例仅有消化道症状。8例以消化系统症状起病,5例以神经系统症状起病,其中2例同时有消化道症状和神经系统症状,1例以呼吸系统症状起病。所有患儿心肌肌钙蛋白I(cTnI)、脑钠肽(BNP)和乳酸脱氢酶(LDH)均升高,中位cTnI水平为5.5(1.4~12.6)ng/L,中位BNP水平为11630.0(6440.0~28152.0)pg/mL,中位LDH水平为642.0(465.5~1194.3)U/L;11例心肌肌钙蛋白T(cTnT)升高(1例未测),中位cTnT水平为1.2(0.3~3.9)ng/L;9例血清肌酸激酶(CK)和肌酸激酶同工酶(CK-MB)升高,中位CK水平为348.5(99.3~674.8)U/L,中位CK-MB水平为35.4(24.5~97.2)U/L。10例患儿D-二聚体升高,中位D-二聚体水平为1.7(0.6~3.3)mg/L。所有患儿入院后心电图和彩色多普勒超声心动图均异常。3例患儿应用体外膜肺氧合(ECMO)。10例(83.3%)患儿好转后出院,2例死亡。结论儿童FM起病症状不典型;心肌酶、心电图和超声心动图的阳性率高;ECMO是救治FM的有效手段。

Objective To analyze the clinical characteristics of fulminant myocarditis(FM)in children,and to provide references for the clinical decision-making of pediatricians.Methods The clinical data of children with FM who were hospitalized in the pediatric intensive care unit(PICU)from October 2019 to October 2022 were retrospectively analyzed.Results Twelve children with FM(5 boys and 7 girls)were included.The median age was 10.0(5.6-12.6)years,the median time from onset of disease to treatment was 5.0(3.0-6.0)days,and the median length of hospital stay was 12.0(11.0-16.8)days.Twelve patients had no specific symptoms,11 had circulatory symptoms,and 1 had gastrointestinal symptoms only.The onset symptoms were as follows:8 children had digestive symptoms,5 children had neurological symptoms,2 children had both digestive and neurological symptoms,and 1 child had respiratory symptoms.The levels of myocardial troponinⅠ(cTnⅠ),brain natriuretic peptide(BNP)and lactate dehydrogenase(LDH)were elevated in all children.The median cTnⅠlevel was 5.5(1.4-12.6)ng/L,the median BNP level was 11630.0(6440.0-28152.0)pg/mL,and the median LDH level was 642.0(465.5-1194.3)U/L.The myocardial troponin T(cTnT)level was elevated in 11 patients(1 child undetected),and the median cTnT level was 1.2(0.3-3.9)ng/L.The levels of serum creatine kinase(CK)and creatine kinase isoenzyme(CK-MB)were elevated in 9 patients,the median CK level was 348.5(99.3-674.8)U/L,and the median CK-MB level was 35.4(24.5-97.2)U/L.The D-dimer levels were elevated in 10 patients,and the median D-dimer level was 1.7(0.6-3.3)mg/L.Electrocardiogram and echocardiography were abnormal in all patients after admission.Three patients were treated with extracorporeal membrane oxygenation(ECMO).Ten patients(83.3%)were discharged after improvement,and 2 died.Conclusions The onset symptoms of FM in children are atypical.The positive rates of myocardial enzyme,electrocardiogram and echocardiography were high.ECMO is an effective method to treat FM.