急性心肌炎住院患者的临床特征及预后相关因素分析

Clinical characteristics and prognostic analysis of adult patients hospitalized with acute myocarditis

目的探讨急性心肌炎住院患者的临床特征,并分析影响预后的相关因素。方法本研究为回顾性队列研究。纳入2010年3月至2022年10月,于哈尔滨医科大学附属第二医院住院治疗的急性心肌炎患者,根据临床诊断结果分为重症心肌炎组和非重症心肌炎组。收集两组的基本临床特征并进行随访,主要终点是心原性死亡,次要终点是心原性再住院。根据临床结局绘制Kaplan-Meier生存曲线并进行log-rank P检验,建立Cox比例风险模型分析影响急性心肌炎患者预后的相关因素。结果共纳入235例急性心肌炎患者,男性138例(58.7%),年龄(34±16)岁,重症心肌炎组102例(43.4%),非重症心肌炎组133例(56.6%)。与非重症心肌炎组相比,重症心肌炎组年龄更大,更多出现呼吸困难、水肿和晕厥的临床症状。随访3.8(2.8,4.8)年,急性心肌炎患者累积心原性死亡率和心原性再住院率分别为4.2%和9.6%。重症心肌炎患者较非重症心肌炎患者心原性死亡和心原性再住院风险更高(分别为9.3%比1.0%,log-rank P=0.004;13.4%比4.2%,log-rank P=0.021)。多因素Cox分析显示,急性心肌炎患者发生心原性死亡的独立危险因素是基线血清肌酐水平升高(HR=1.016,95%CI:1.003~1.028,P=0.013);心原性再住院的独立危险因素是入院时左心室舒张末期内径增大(HR=1.108,95%CI:1.035~1.187,P=0.003)和住院期间发生室性心动过速或心室颤动(HR=6.563,95%CI:2.138~20.142,P=0.001)。结论急性心肌炎患者更多出现呼吸困难、水肿和晕厥的症状。基线血清肌酐水平升高是急性心肌炎患者发生心原性死亡的独立危险因素,入院时左心室末期内径增大和住院期间发生室性心动过速或心室颤动是心原性再住院的独立危险因素。

Objective To analyze the clinical characteristics of patients hospitalized with acute myocarditis and explore the relevant factors affecting the prognosis.Methods This study was a retrospective cohort study.Patients with acute myocarditis hospitalized in the Second Affiliated Hospital of Harbin Medical University from March 2010 to October 2022 were included and divided into severe myocarditis group and non-severe myocarditis group according to clinical diagnosis results,retrospectively.Basic clinical features were collected and followed up in both groups.The primary endpoint was cardiac death and the secondary endpoint was cardiac re-hospitalization.According to the clinical outcome,Kaplan-Meier survival curve was drawn and assessed via log-rank P test.Cox proportional risk model was established to analyze the related factors affecting the prognosis of patients with acute myocarditis.Results A total of 235 patients with acute myocarditis were included,including 138 males(58.7%),aged(34±16)years,102 patients(43.4%)in the severe myocarditis group and 133 patients(56.6%)in the non-severe myocarditis group.Compared with the non-severe myocarditis group,the severe myocarditis group was older and had more clinical symptoms of dyspnea,edema,and syncope.At a follow-up of 3.8(2.8,4.8)years,cumulative cardiac mortality and cardiac readmissions in patients with acute myocarditis were 4.2%and 9.6%,respectively.Among them,patients with severe myocarditis had a higher risk of cardiac death and cardiac readmission than those without severe myocarditis(9.3%vs.1.0%,log-rank P=0.004;13.4%vs.4.2%,log-rank P=0.021).Multivariate Cox analysis showed that the independent risk factor for cardiac death in patients with acute myocarditis was elevated serum creatinine level at baseline(HR=1.016,95%CI:1.003-1.028,P=0.013).Independent risk factors for cardiogenic readmission were increased left ventricular end-diastolic diameter on admission(HR=1.108,95%CI:1.035-1.187,P=0.003)and ventricular tachycardia or fibrillation during hospitalization(HR=6.563,95%CI:2.138-20.142,P=0.001).Conclusions The patients with acute myocarditis had more clinical symptoms of dyspnea,edema,and syncope.Elevated serum creatinine level on admission was an independent risk factor for cardiac death in patients with acute myocarditis;increased end-left ventricular diameter on admission and ventricular tachycardia or fibrillation during hospitalization were independently associated with cardiac rehospitalization.