暴发性心肌炎病理及病原学检查1例报告并误诊文献复习  

Pathological and etiological examination of fulminant myocarditis:one case and misdiagnosed cases literature analysis

作　　者：田禹 赵枢泉 王茜 童鑫 刘宇 尹敏 石青[1] 周亦武[1] TIAN Yu;ZHAO Shu-quan;WANG Qian;TONG Xin;LIU Yu;YIN Min;SHI Qing;ZHOU Yi-wu(Department of Forensic Medicine,Tongji Medical College,Huazhong University of Science and Technology,Hubei Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院法医学系,湖北武汉430030

出　　处：《内科急危重症杂志》2022年第6期455-459,共5页Journal of Critical Care In Internal Medicine

基　　金：国家病毒资源库共建合作(No:20211418)。

摘　　要：目的:研究暴发性心肌炎误诊死亡1例病理和病原学检查,并总结暴发性心肌炎误诊病例的特点,减少临床误诊、漏诊率。方法:收集1例暴发性心肌炎误诊死亡患者的临床资料、尸检结果及病原学检查结果,并检索国内数据库,总结143例暴发性心肌炎误诊患者的病例特点。结果:本例尸检发现心肌间质大量单核细胞、淋巴细胞浸润,炎细胞灶性聚集或吞噬心肌细胞现象等病理改变,病原学证实为肠道病毒71A型(EV71A)病毒感染。143例暴发性心肌炎误诊患者中男:女约为1:1.12。误诊为消化系统疾病(63.2%)最常见。在大部分误诊病例记录中,心电图等心功能检查均发现异常指征。143例病例中仅5例进行过病理活检,13例进行过病原学检查。在已知预后信息的病例中治愈或好转占50.9%,死亡占49.1%。结论:暴发性心肌炎起病急骤,早期死亡率高,常以心外表现为首发症状,临床上应尽早做心功能检查,及时采取相应救治措施。Objective:To investigate the pathology and etiology of one case of misdiagnosed death from fulminant myocarditis and summarize the characteristics of misdiagnosis cases of fulminant myocarditis,and to reduce the rate of clinical misdiagnosis and omission.Methods:The forensic and etiological results of a deceased patient with fulminant myocarditis misdiagnosed were collected,and domestic database was searched to summarize the characteristics of 143 patients with fulminant myocarditis misdiagnosis.Results:The autopsy of this case revealed pathological changes such as a large number of mononuclear cells and lymphocytes infiltrating the interstitial myocardium,focal aggregation of inflammatory cells or phagocytosis of cardiomyocytes,and the etiology was confirmed as Enterovirus 71A(EV71A)virus infection.Among 143 cases of misdiagnosed fulminant myocarditis,the ratio of male:female was about 1:1.12.The most frequently misdiagnosed disease type was digestive system disease,accounting for 63.2%.The majority of the misdiagnosed cases were found to have abnormal indications for cardiac function tests such as ECG.In 143 cases,only 5 cases underwent pathological biopsy test,and only 13 cases were subjected to etiological test.50.9%of cases with known prognostic information were cured or improved and 49.1%of cases died.Conclusion:Fulminant myocarditis has a rapid onset,high early mortality,and often presents with extracardiac manifestations as the first symptom.In clinical practice,cardiac function tests should be done as early as possible and Chinese program is used to take appropriate rescue measures in time.

关 键 词：暴发性心肌炎 误诊 病原学检测 EV71病毒 

分 类 号：R542.2[医药卫生—心血管疾病]