应激性心肌病和暴发性心肌炎患者临床特征及近期预后比较

Comparison of clinical characteristics and prognosis in patients with stress cardiomyopathy and fulminant myocarditis

目的比较应激性心肌病和暴发性心肌炎患者的临床特征及30 d预后。方法回顾性分析2012年5月至2019年12月由中国医学科学院阜外医院重症监护病房收治的确诊为应激性心肌病(n=23)患者和暴发性心肌炎(n=17)患者住院的临床资料,随访患者住院期间和确诊30 d时预后情况。结果与应激性心肌病患者组比较,暴发性心肌炎组患者年龄轻[(64.9±12.1)岁比(42.0±13.7)岁,P<0.001],女性比例低(56.0%比30.3%,P=0.037),就诊时收缩压低[(119.1±16.2)mmHg比(95.5±12.4)mmHg,P<0.001],心率快[(79.6±18.9)次/min比(103.3±26.8)次/min,P=0.001],发病到就诊的时间有明显的延迟(1 d比4 d,P=0.005);血液化验方面,肌钙蛋白I升高幅度更大[0.750(0.086,1.645)ng/mL比9.636(2.575,11.570)ng/mL,P<0.001],N末端B型利钠肽原水平更高[2086.4(954.4,3360.0)pg/mL比26145.0(21301.5,44425.0)pg/mL,P=0.001],C反应蛋白水平更高[5.55(2.78,8.57)mg/L比37.60(20.30,73.95)mg/L,P<0.001];超声心动图检查结果显示,与应激性心肌病患者比较,暴发性心肌炎患者组就诊时左心室射血分数下降更明显[(45.5±9.2)%比(35.5±7.3)%,P=0.002],恢复期左心室内径更大[(44.6±4.6)mm比(49.4±6.7)mm,P=0.016]。暴发性心肌炎患者组30 d生存率明显低于应激性心肌病患者(64.7%比100%,P=0.002)。结论与应激性心肌病患者组相比,暴发性心肌炎患者组发病年龄更轻,肌钙蛋白增高幅度更大,心功能损伤更严重,炎症反应更强烈,30 d预后更差。

Objective To compare the clinical features and prognosis of patients with Tako-Tsubo syndrome(TTS)or fulminant myocarditis(FM).Methods Patients diagnosed with TTS or FM from May 2012 to December 2019 in Fuwai Hospital were collected.A total of 40 patients were included in the study,including 23 patients with TTS,and other 17 patients with FM.Clinical features,hospital related examination results,treatment and 30 d prognosis of these two groups were compared.Results Compared to patients with TTS patients with FM was younger[(64.9±12.1)years vs.(42.0±13.7)years,P<0.001],had lower systolic blood pressure at admission[(119.1±16.2)mmHg vs.(95.5±12.4)mmHg,P<0.001],higher heart rate at admission[(79.6±18.9)bpms vs.(103.3±26.8)bpms,P=0.001],a marked delay in onset to presentation(1 d vs.4 d,P=0.005),higher level of cardiac troponin I[0.750(0.086,1.645)ng/mL vs.9.636(2.575,11.570)ng/mL,P<0.001],higher level of N terminal-pro B type natriuretic peptide(NT-proBNP)[2086.4(954.4,3360.0)pg/mL vs.26145.0(21301.5,44425.0)pg/mL,P=0.001],higher level of C-reactive protein[5.55(2.78,8.57)mg/L vs.37.60(20.30,73.95)mg/L,P<0.001].As for parameters of echocardiography,patients with FM had a lower left ventricular ejection fraction at presentation[(35.5±7.3)%vs.(45.5±9.2)%,P=0.002]and greater left ventricular end diastolic diameter during recovery[(49.4±6.7)mm vs.(44.6±4.6)mm,P=0.016]than those with TTS.Moreover,patients with FM had a lower survival rate at 30 d than those with TTS(64.7%vs.100%,P=0.002).Conclusions Compared to patients with TTS,patients with FM had a younger age of onset,a greater increase in troponin I,a stronger inflammatory response,more severe cardiac impairment and a worse prognosis at 30 d.