儿童暴发性心肌炎免疫调节治疗进展

Advances in Immunomodulatory Treatment for Fulminant Myocarditis in Children

儿童暴发性心肌炎是儿童急性心肌炎中最严重的类型,以起病急骤、进展迅猛为特点,且临床表现不典型,常以心外表现为主,是一种极易误诊、漏诊的急症。若能早期识别暴发性心肌炎患儿并给予积极有效的治疗和生命支持,可显著降低其死亡率,远期的预后也相对良好。目前对于儿童FM的治疗方法主要采用机械循环支持、正性肌力药物、抗心律失常药物、抗病毒药物、免疫调节药物等治疗。目前免疫调节药物主要包括糖皮质激素、静脉丙种球蛋白、其他免疫抑制剂等。现国内外有报道表明,若在早期使用免疫调节治疗,可以显著改善FM患儿的心脏功能,降低住院期间死亡率。但鉴于国内外对于免疫调节治疗仍存有争议,尚未得到广泛认可,没有规范化治疗标准,该文就儿童FM应用免疫调节药物治疗进展进行综述。

Fulminant myocarditis (FM) is the most serious type of acute myocarditis in children, which is characterized by rapid onset, rapid progression, and lack of specificity in clinical manifestations, of-ten appears with extracardiac symptoms. It’s easy to be misdiagnosed and missed diagnosis. If the children with FM can be identified early and given actively effective treatment and life support, their mortality rate can be significantly reduced, and the long-term prognosis is relatively good. At present, the treatment of FM in children mainly use mechanical circulation support, inotropic drugs, antiarrhythmic drugs, antiviral drugs, immunomodulatory drugs and other treatments. Immunomodulatory drugs mainly include corticosteroids, intravenous immunoglobulin, and other immunosuppressants. Some reports at home and abroad show that if the immunomodulatory therapy is used in the early stage, it can significantly improve the cardiac function of the children with FM and reduce the mortality rate during the hospital period. In view of the controversy about immunomodulatory therapy at home and abroad, it has not been widely recognized, and without standardized treatment standard. This article reviews the progress of using immunomodulatory drugs in children with FM.