小儿心肌炎的诊治进展

Progress in the diagnosis and treatment of pediatric myocarditis

心肌炎是一种由多种因素引起的心肌炎性疾病,最常见的病原体为肠道病毒,其次是呼吸道病毒(尤其是新型冠状病毒)以及支原体、立克次体、弓形体等。心肌炎时由于心肌易感性增强,心律失常的发生概率相对较高,其类型可能对疾病的进展及预后有着提示作用。通过心电图、动态心电图来观察心脏电生理改变,超声心动图、心脏核磁共振发现心肌内部结构和左室收缩功能的特异改变以协助诊断。对于心肌炎的治疗,除了一般治疗外,可根据病情应用静脉用丙种球蛋白、糖皮质激素以及某些细胞因子的受体拮抗剂等。心肌炎的预后与心肌炎的类型、进展速度、心肌损伤的程度、心脏电生理的改变情况及心脏结构的改变有关。

Myocarditis is an inflammatory disease of myocardium caused by a variety of factors.The most common etiology is enterovirus,followed by respiratory viruses,especially the new coronaviruses,mycoplasma,rickettsia,and toxoplasma,etc.The probability of arrhythmia is relatively high in myocarditis due to increased myocardial susceptibility,and its type may be suggestive of disease progression and prognosis.Electrophysiological changes in the cardio-myocytes are observed by electrocardiography and ambulatory electrocardiography.Echocardiography and cardiac magnetic resonance are used to detect specific changes in the internal structure of the myocardium and left ventricular systolic function and to assist in the diagnosis.For the treatment of myocarditis,in addition to general treatment,according to the needs of the condition,intravenous immunoglobulin,glucocorticoids,and receptor antagonists of some cytokines can be used.The prognosis of pediatric myocarditis is related to the type of myocarditis,the speed of progression,the degree of myocardial damage,the electrophysiological changes and the structural changes of the heart.