儿童暴发性心肌炎诊断研究进展  

Advances in the diagnosis of pediatric fulminant myocarditis

作　　者：王心怡 韩波 Wang Xinyi;Han Bo(Cheeloo College of Medicine,Shandong University,Jinan250021,China;Department of Pediatric Cardiology,Shandong Provincial Hospital,Jinan250021,China;Shandong Provincial Hospital,Shandong Provincial Clinical Research Center for Children's Health and Disease Office,Jinan250021,China)

机构地区：[1]山东大学齐鲁医学院,济南250021 [2]山东省立医院小儿心脏科,济南250021 [3]山东省立医院、山东省儿童健康与疾病临床医学研究中心,济南250021

出　　处：《国际儿科学杂志》2024年第11期735-739,共5页International Journal of Pediatrics

基　　金：济南市科学技术局科技发展计划(202134015);山东省教育厅泰山学者特聘专家项目(201511099)。

摘　　要：暴发性心肌炎(fulminant myocarditis,FM)是一种罕见且独特的心肌炎,病情进展迅速,早期病死率高。儿童FM的发病率明显高于成人,且儿童FM多以消化道、呼吸道等心外症状为首发表现,故早期识别并及时给予治疗至关重要。感染因素及非感染因素均可导致儿童FM。在非特异性的前驱表现出现后,在排除鉴别诊断的基础上,迅速出现的严重血流动力学改变、相关生物标志物(肌钙蛋白、炎症因子等)的显著升高、心电图的异常(恶性心律失常、ST段改变等)、超声心动图的特征(左室射血分数降低、室壁运动减低等)以及心脏MRI的特异性表现,有助于临床诊断FM。另外,心内膜心肌活检仍是诊断FM的金标准,可指导进一步的治疗。该文主要对儿童FM诊断的研究进展进行综述,以期为临床工作提供参考。Fulminant myocarditis(FM)is a rare and unique form of myocarditis with rapid progression and high early mortality.The incidence of FM in children is significantly higher than that in adults,and FM in children is often first manifested by extracardiac symptoms such as gastrointestinal and respiratory symptoms,so early identification as well as early and timely treatment may be crucial.Both infective and non-infective factors can cause FM in children.After the emergence of non-specific prodromal symptoms and on the basis of excluding differential diagnosis,rapid severe hemodynamic changes,significant increases in related biomarkers(troponin,inflammatory factors,etc.),abnormalities in electrocardiogram(malignant arrhythmia,ST segment changes,etc.),echocardiographic features(decreased left ventricular ejection fraction,wall hypokinesia,etc.),and specific manifestations of cardiac MRI are helpful for clinical diagnosis of FM.In addition,endomyocardial biopsy is still the gold standard for the diagnosis of FM and can guide further treatment.This article mainly reviews the research progress of FM diagnosis in children,in order to provide reference for clinical work.

关 键 词：儿童 暴发性心肌炎 诊断 

分 类 号：R725.4[医药卫生—儿科]