婴儿心肌炎临床特征分析

Analysis of clinical features in infants with myocarditis

目的:分析总结婴儿心肌炎的临床特征。方法:采用回顾性分析,整理2010年1月至2021年8月在郑州大学第一附属医院收治的94例婴儿心肌炎病例,分析婴儿心肌炎临床特征。结果:94例病例分成2组,≤3月龄组(A组)和3~12月龄组(B组);两组的基线资料(性别、分娩方式、喂养方式)差异无统计学意义(P>0.05)。一般临床资料:A组非特异性症状发生率78.4%明显高于B组54.4%(P=0.018),心功能不全、心源性休克、心脑综合征发生率(P>0.05)、前驱感染史(P>0.05),均差异无统计学意义。心功能指标及心肌酶学:A组BNP中位值1625.5(478.0,5253.8)pg/mL高于B组426.0(212.5,2345.0)pg/mL,差异具有无统计学意义(P=0.017),余CTNT、CK、CK-MB、LDH两组间差异无统计学意义(P>0.05)。血清病原学:A组EBV阳性率79.4%高于B组48.0%(P=0.004),余CMV及其他病原差异无统计学意义(P>0.05)。Holter显著心律失常发生率:两组差异无统计学意义(P>0.05)。Holter显著心律失常类型:A组房性心律失常发生率明显高于B组(P=0.001),但B组室性心律失常发生率明显高于A组(P=0.004),余心律失常类型两组间差异无统计学意义(P>0.05)。Holter显著心律失常经治疗后改善率:A组改善率80.0%明显高于B组54.5%(P=0.032)。Holter显著心律失常明显改善病例用药分析:A组与B组两组在使用特殊药物(人免疫球蛋白、激素、抗心律失常药)两组间差异无统计学意义(P>0.05)。结论:婴儿心肌炎在≤3月龄和3~12月龄两个阶段呈现一定差异,实验室检查中≤3月龄组BNP、EB病毒率明显高于3~12月龄组婴儿。心电方面:≤3月龄婴儿更易发生房性心律失常,而3~12月龄婴儿更易发生室性心律失常,且前者的治疗效果好于后者。

Objective:To analyze and summarize the clinical features of infants with myocarditis.Methods:Retrospective analysis was used,sorted out medical materials of 94 infants with myocarditis who admitted in the first affiliated hospital of Zhengzhou University from January 2010 to August 2021,and analyzed the clinical features.Results:94 infant-cases were divided into 2 groups,≤3 months group(Group A)and 3~12 months group(Group B).Baseline data(gender,delivery method,feed method),there was no statistical difference between the two groups(P>0.05);General clinical data:the incidence of non-specific symptoms in Group A was significantly higher than that in Group B(P=0.018),and the incidence of cardiac insufficiency,cardiogenic shock,and heart-brain syndrome(P>0.05);the history of pre-infection(P>0.05),there was no statistical difference;The index of cardiac function and myocardial enzymes:the median value of BNP of Group A was higher than that in Group B(P=0.017),and there was no statistical difference between CTNT,CK,CK-MB,and LDH(P>0.05);Serum etiology:The EBV positive rate of Group A was higher than that in Group B(P=0.004).there was no significant difference in CMV and other pathogens(P>0.05);The incidence of significant arrhythmia of Holter ECG:there was no statistical difference between the two groups(P>0.05);Types of significant arrhythmia of Holter ECG:the incidence of atrial arrhythmia in Group A was significantly higher than that in Group B(P=0.001),but the incidence of ventricular arrhythmia in Group B was significantly higher than that in Group A(P=0.004),and there was no statistical difference in other types of arrhythmia between the two groups(P>0.05);Improvement rate of Holter ECG after treatment:the improvement rate of Group A was significantly higher than that in Group B(P=0.032);Medication of the cases of significant arrhythmia improvement:Group A and Group B were using special drugs(human immunoglobulin,hormones,antiarrhythmic drugs),there was no statistical difference between the two groups(P>0.05).Conclusion:Infant myocarditis showed a certain difference in the two stages of≤3 months and 3~12 months.In laboratory examinations,the BNP and Epstein-Barr virus rates of≤3 months old group were significantly higher than those of 3~12 months old group.In terms of ECG:Infants of≤3 months were more likely to develop atrial arrhythmia,while infants of 3 to 12 months were more likely to develop ventricular arrhythmia.The treatment effect of the former was better than that of the latter.