新生儿心肌炎伴有B型钠尿肽升高的病因及临床特点分析  

Analysis of the Etiology and Clinical Characteristics of Neonatal Myocarditis Accompanied by Elevated B-type Natriuretic Peptide

作　　者：朱琳 刘桂英[1] 苏瑛[1] 王继秋[1] 董云[1] Zhu Lin;Liu Guiying;SuYing;Wang Jiqiu;Dong Yun(Department of Pediatric,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;不详)

机构地区：[1]首都医科大学附属北京安贞医院儿科,北京市100029

出　　处：《中国病案》2025年第3期103-106,共4页Chinese Medical Record

基　　金：北京市科技计划项目(Z111107067311030);北京市临床重点专科建设项目(2-1-2-18-300)。

摘　　要：目的探讨新生儿心肌炎伴有B型钠尿肽升高的病因及临床特点,以提高对新生儿心肌炎的认识,为临床诊治提供参考。方法取2019年6月11日—2022年6月26日在儿科住院的20例心肌炎患儿进行回顾性分析,依据伴有BNP升高的新生儿心肌炎和不伴有BNP升高的新生儿心肌炎进行分组,分别为伴有组和不伴有组,应用t检验和χ^(2)检验分析伴有BNP升高的新生儿心肌炎的病因、临床特点和预后。结果伴有组共11例,占同期新生儿心肌炎病例的55%(11/20);发病相关病因包括单纯疱疹病毒感染、细小病毒B19感染,感染率与不伴有BNP升高的心肌炎患儿(9例)比较,差异有统计学意义;胎龄、出生体重小于不伴有BNP升高的心肌炎患儿,差异有统计学意义;胎儿宫内窘迫率、神经系统症状发生率高于不伴有组、无症状率低于不伴有组,差异均有统计学意义。伴有组11例中6例存在心律失常(54.5%),不伴有组9例中5例存在心律失常(55.5%),2组间差异无统计学意义,此11例心律失常患儿进行了心脏磁共振检查,10例异常者应用地塞米松减轻炎症渗出,联合应用丙种球蛋白中和炎性因子、调节免疫,3例后期加用抗心律失常药物。随访期间2组患儿心肌酶均正常,心律失常无反复,除伴有组中1例心脏彩超、心脏磁共振未完全恢复,余心脏彩超、心脏磁共振均未见明显异常。结论伴有BNP升高的新生儿心肌炎起病隐匿,多见于胎儿宫内窘迫,常并发神经系统症状,宫内感染是主要病因;经积极治疗,伴有BNP升高的新生儿心肌炎的预后与不伴有BNP升高的新生儿心肌炎的预后无明显差异。Objectives This study aims to explore the etiology and clinical characteristics of neonatal myocarditis with elevated BNP to improve the understanding of neonatal myocarditis and provide reference for clinical diagnosis and treatment.Methods Twenty children with myocarditis hospitalized in the pediatric department from June 11,2019 to June 26,2022 were selected for retrospective analysis.Neonatal myocarditis with elevated BNP and neonatal myocarditis without elevated BNP were grouped,and the etiology,clinical characteristics and prognosis of neonatal myocarditis with elevated BNP were analyzed.Results There were total of 11 cases of neonatal myocarditis with elevated BNP,accounting for 55%(11/20)of cases of neonatal myocarditis during the same period.The causes of the disease included herpes simplex virus infection and parvovirus B19 infection.The infection rate was statistically significant compared with that of children with myocarditis without elevated BNP(9 cases).The gestational age and birth weight of the children with myocarditis were lower than those without elevated BNP,and the difference was statistically significant.The rates of intrauterine fetal distress and neurological symptoms were higher than those in the neonatal myocarditis group without elevated BNP,and the asymptomatic rate was lower than that in the neonatal myocarditis group without elevated BNP,and the differences were statistically significant.Among the 11 cases of neonatal myocarditis with elevated BNP,6 cases had arrhythmias(54.5%),while among the 9 cases of neonatal myocarditis without elevated BNP,5 cases had arrhythmias(55.5%).There was no statistically significant difference between the two groups.These 11 cases of arrhythmias underwent cardiac magnetic resonance imaging,and 10 cases with abnormalities were treated with dexamethasone to reduce inflammatory exudation,combined with immunoglobulin to neutralize inflammatory factors and regulate immunity.In the later stage,3 cases were treated with antiarrhythmic drugs.During the follow

关 键 词：新生儿 心肌炎 B型钠尿肽 心脏磁共振 

分 类 号：R722.1[医药卫生—儿科]