暴发性心肌炎与非暴发性心肌炎患者的远期预后及心功能受损的危险因素分析  

Long-term prognosis and risk factors for impaired heart function in patients with fulminant myocarditis or without fulminant myocarditis

作　　者：裴蕊慧 王敏 Pei Ruihui;Wang Min(Department of Intensive Care Medicine,Hospital of Traditional Chinese Medicine of Baoji City,Baoji 721001,China;不详)

机构地区：[1]宝鸡市中医医院重症医学科,宝鸡721001 [2]宝鸡市中心医院心血管内科,宝鸡721001

出　　处：《中国循证心血管医学杂志》2023年第12期1359-1362,1368,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨暴发性心肌炎(FM)与非爆发性心肌炎(NFM)患者的远期预后差异,分析患者心功能受损的相关影响因素。方法采用回顾性分析法,选取经救治后成功出院的急性心肌炎患者作为研究对象,其中暴发性心肌炎63例(FM组)、非暴发性心肌炎42例(NFM组),收集患者入院时的病历资料,并对其远期预后进行随访及比较。复查暴发性心肌炎患者出院后的超声心动图,分析超声心动图改变,对比心功能正常与心功能受损患者的临床资料,分析暴发性心肌炎患者心功能受损的影响因素。结果与NFM组相比,FM组患者年龄更大,入院收缩压(SBP)、舒张压(DBP)水平更低,白细胞计数(WBC)、中性粒细胞百分比(NEUT)、C反应蛋白(CRP)、降钙素原(PCT)、肌钙蛋白I(cTnI)、N末端脑钠肽前体(NT-proBNP)、D-二聚体(D-D)水平及住院左室射血分数(LVEF)最低值<55%占比均更高,LVEF恢复时间更长(P<0.05)。两组入院时的左房内径(LAD)、左室舒张末期内径(LVEDD)水平比较,差异无统计学意义(P>0.05)。与NFM组相比,FM组的室间隔厚度(IVST)、左心室后壁厚度(LVPWT)水平更高,每搏输出量(SV)、LVEF水平更低,差异有统计学意义(P<0.05)。FM组出院后心功能受损16例(25.40%),NFM组心功能受损2例(4.76%),FM组心功能受损率明显高于NFM组(P<0.05)。再将FM组分为心功能受损与心功能正常两个亚组,与心功能正常组相比,心功能受损组的LVEF恢复时间更长,出院LVEF<55%占比更高(P<0.05)。多因素分析显示,LVEF恢复时间是暴发性心肌炎患者随访期间心功能受损的独立危险因素(HR=1.202,95%CI:1.101~1.592,P=0.017)。结论相比非暴发性心肌炎,暴发性心肌炎患者的远期预后更差,心功能受损发生率更高,住院期间LVEF恢复时间长是患者出院后心功能受损的独立危险因素。Objective To discuss the difference in long-term prognosis in patients with fulminant myocarditis(FM)and patients without FM,and to analyze influence factors related to impaired heart function.Methods The patients with acute myocarditis discharged after successful rescue were chosen by using retrospective analysis,including 63 cases of FM(FM group)and 42 cases of non-FM(NFM group).The medical history materials were collected from the patients,and long-term prognosis was followed up and compared.Echocardiography was rechecked and analyzed in FM patients after they were discharged.The clinical materials were compared between patients with normal heart function and patients with impaired heart function.The influence factors of impaired heart function were analyzed.Results Compared with NFM group,in FM group age was elder,admission systolic blood pressure(SBP)and diastolic blood pressure(DBP)were lower,levels of white blood cell count(WBC),neutrophil count(NEUT),C-reactive protein(CRP),procalcitonin(PCT),cardiac troponin I(cTnI),N-terminal pro-brain natriuretic peptide(NT-proBNP)and D-dimer(D-D)and percentage of the lowest value of admission left ventricular ejection fraction(LVEF)<55%were higher,and LVEF recovery time was longer(P<0.05).The differences in admission left atrial diameter(LAD)and left ventricular end-diastolic diameter(LVEDD)had no statistical significance between 2 groups(P>0.05).The levels of interventricular septal thickness(IVST)and left ventricular posterior wall thickness(LVPWTT)were higher,and levels of stroke volume(SV)and LVEF were lower in FM group than those in NFM group(P<0.05).There were 16 patients(25.40%)with impaired heart function in FM group and 2(4.76%)in NFM group(P<0.05).The FM group was further divided into impaired heart function subgroup and normal heart function subgroup.The recovery time of LVEF was longer and percentage of discharge LVEF<55%was higher in impaired heart function subgroup than those in normal heart function subgroup(P<0.05).The results of multi-factor analysis

关 键 词：爆发性心肌炎 非爆发性心肌炎 远期预后 心功能受损 

分 类 号：R542.2[医药卫生—心血管疾病]