病毒性心肌炎患儿预后不良的危险因素分析及预测模型建立  

Risk Factors Analysis and Prediction Model Establishment of Adverse Prognosis in Children with Viral Myocarditis

作　　者：张玉杰 陈培玲 金凌晖 黄惠毅 傅明鸿 ZHANG Yujie;CHEN Peiling;JIN Linghui;HUANG Huiyi;FU Minghong(Children's Hospital of Quanzhou Maternal and Child Health Hospital,Quanzhou 362000,China)

机构地区：[1]泉州市妇幼保健院儿童医院,福建泉州362000

出　　处：《中国医药指南》2020年第22期93-94,共2页Guide of China Medicine

摘　　要：目的分析泉州地区儿童病毒性心肌炎患者出现预后不良事件的高危风险因素,并建立风险预测模型,以利于早期预测,改善预后。方法回顾性分析泉州儿童医院2014年3月至2019年5月收治的225例儿童病毒性心肌炎患者,根据住院及出院随访1年是否出现不良预后事件将患儿分为预后不良组35例与预后良好组190例。结果预后不良组爆发性心肌炎比例明显高于预后良好组(P<0.01)。对比两组各项临床指标共8项差异有统计学意义(P<0.05),单因素Logistic回归分析出6个指标存在相关性并纳入进行多因素Logistic回归分析,结果显示治疗中使用肾上腺素,入院时SDNN≤87 ms、QT间期延长≥479 ms、LVEF≤48.00%、TnI≥1.26μg/L是儿童病毒性心肌炎患者预后不良的独立危险因素,并根据上述因素建立预测评分系统。35例预后不良组患儿中有28例出院诊断为爆发性心肌炎,占比80.00%;190例预后良好组患儿中有27例爆发性心肌炎,占比14.21%。结论入院时SDNN下降、TnI升高、QT间期延长、LVEF下降、治疗中使用肾上腺素是预后不良的独立危险因素;本研究中建立的评分系统对于泉州地区儿童病毒性心肌炎患者预后不良的预测效能较好。Objective To study and analyze the high-risk factors of adverse prognosis and adverse events in children with viral myocarditis in Quanzhou area,and establish a risk prediction model to facilitate early prediction and improve prognosis.Methods A retrospective analysis of 225 cases of children with viral myocarditis admitted to Quanzhou children’s Hospital from March 2014 to may 2019 was conducted.According to whether adverse prognostic events occurred during the 1-year follow-up period of hospitalization and discharge,the children were divided into poor prognosis group(35 cases)and good prognosis group(190 cases).Results The proportion of fulminant myocarditis in poor prognosis group was significantly higher than that in good prognosis group(P<0.01).Compared with the two groups,there were 8 clinical indicators,the difference was statistically significant(P<0.05).Univariate logistic regression analysis showed that six indexes were correlated and were included in the multivariate logistic regression analysis.The results showed that when adrenaline was used in treatment,SDNN≤87 MS,QT interval extension≥479 MS,LVEF≤48.00%,TnI≥1.26μg/l was an independent risk factor for poor prognosis in children with viral myocarditis,and a predictive scoring system was established based on the above factors.In 35 cases of poor prognosis group,28 cases were diagnosed as fulminant myocarditis,accounting for 80.00%;there were 27 cases of fulminant myocarditis in 190 cases of good prognosis group,accounting for 14.21%.Conclusion On admission,SDNN decreased,TnI increased,QT interval prolonged,LVEF decreased,and the use of adrenalin in treatment were independent risk factors for poor prognosis;the score system established in this study was effective for Quanzhou The prediction of poor prognosis in children with viral myocarditis is good.

关 键 词：病毒性心肌炎 儿童 不良预后 预测评分系统 LOGISTIC回归分析 

分 类 号：R725.4[医药卫生—儿科]