暴发性心肌炎患者的长期预后及心功能受损的危险因素分析  

Long term prognosis of fulminant myocarditis and predictors related to impaired cardiac function post discharge

作　　者：蒋建刚[1] 刘超 崔广林 陈琛 左后娟 李瑞 汪道文[1] Jiang Jiangang;Liu Chao;Cui Guanglin;Chen Chen;Zuo Houjuan;Li Rui;Wang Daowen(Department of Cardiology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院心内科,武汉430030

出　　处：《中华心血管病杂志》2022年第3期263-269,共7页Chinese Journal of Cardiology

基　　金：国家自然科学基金(81790624,81873505);国家自然科学基金委员会中德科学中心新型冠状病毒中德合作研究应急专项(C-0052);同济医院临床研究领航项目(2019CR207)。

摘　　要：目的比较生存出院的暴发性心肌炎(FM)和非暴发性心肌炎(NFM)患者的远期预后,并分析FM患者出院后心功能受损的危险因素。方法该研究为回顾性研究。连续纳入2017年1月至2020年12月于华中科技大学同济医学院附属同济医院心血管内科住院的急性心肌炎患者,根据心肌炎的类型分为FM组和NFM组。然后,根据左心室射血分数(LVEF)是否持续<55%,将FM组患者进一步分为心功能正常组和心功能受损组。所有急性心肌炎患者均给予抗病毒、免疫调节、免疫抑制及对症支持治疗,FM患者均采用"综合救治方案"进行救治。通过电子病历系统收集入选患者基线(入院时)临床资料。患者出院后第1、3、6和12个月返院随访,以后每年随访1次。主要观察终点包括主要不良心脑血管事件、LVEF持续<55%和左心室增大。采用Kaplan-Meier生存曲线分析FM组及NFM组患者随访过程中发生LVEF持续<55%及左心室持续增大的情况,并采用Log-rank检验进行组间比较。采用Cox回归模型分析FM患者心功能受损的危险因素。结果共入选急性心肌炎患者125例,其中FM组66例、NFM组59例。与NFM组比较,FM组患者住院期间LVEF最低值<55%者比例较高(P<0.01)、住院期间LVEF恢复时间较长(P<0.01)。两组患者出院时LVEF<55%者比例相当(P=0.071)。随访12(6,24)个月,FM组1例(1.5%)患者出院后发生心原性死亡,16例(24.2%)患者出院后LVEF持续<55%,8例(12.1%)患者左心室增大;NFM组3例(5.1%)患者LVEF持续<55%,1例(1.7%)患者左心室增大。Kaplan-Meier生存曲线分析结果显示,FM组患者LVEF持续<55%的发生率高于NFM组(P=0.003),左心室增大的比率亦高于NFM组(P=0.024)。FM组患者的亚组分析结果显示,与心功能正常组比较,心功能受损组起病至入院时间更短(P=0.011)、出院时LVEF<55%占比更高(P=0.039)、接受冠状动脉造影的比例更高(P=0.014)、住院期间LVEF恢复时间更长(P=0.036)。多因素Cox回归�Objective To compare the long-term prognosis of fulminant myocarditis(FM)and non-fulminant myocarditis(NFM)patients who survived and discharged from hospital,and to explore the factors associated with the long-term prognosis and impaired cardiac function.Methods This study was a retrospective study.Consecutive patients with acute myocarditis hospitalized in Tongji Hospital from January 2017 to December 2020 were enrolled and divided into FM group and NFM group according to the type of myocarditis.Then,patients in the FM group were further divided into normal cardiac function group and impaired cardiac function group according the left ventricular ejection fraction(LVEF).All patients with acute myocarditis were treated with antiviral,immunomodulatory,immunosuppressive medications and symptomatic and supportive treatment,while FM patients were treated with comprehensive treatment plan.Clinical data at admission of enrolled patients were collected through the electronic medical record system.Patients were clinically followed-up at 1,3,6 and 12 months,then once a year after discharge by clinical visit.The primary endpoints included major cardiovascular events,impaired cardiac function was defined by LVEF<55%.Kaplan-Meier survival curve was used to analyze the occurrence of LVEF<55%and left ventricular enlargement during the follow-up of patients in FM group and NFM group,and Log-rank test was used for comparison between groups.Cox regression model was used to analyze the risk factors of impaired cardiac function in patients with FM during follow-up.Results A total of 125 patients with acute myocarditis were enrolled(66 in FM group and 59 in NFM group).Compared with NFM group,the proportion of FM patients with the lowest LVEF<55%during hospitalization was higher(P<0.01),and the recovery time of normal LVEF during hospitalization was longer(P<0.01).The proportion of LVEF<55%at discharge was similar between the two groups(P=0.071).During the follow-up of 12(6,24)months,1 patient(1.5%)died due to cardiac reasons in FM gr

关 键 词：心肌炎 预后 危险因素 左心室射血分数 

分 类 号：R542.21[医药卫生—心血管疾病]