2018 年第 10 期 第 13 卷

入院时左心室射血分数减低的成年急性心肌炎患者临床特点分析

Clinical characteristics of acute myocarditis with low left ventricular ejection fraction in adults

作者：赵晗刘文娴任燕龙宁尚秋何卫红

英文作者：

单位：100029首都医科大学附属北京安贞医院心内科北京市心肺血管疾病研究所心血管疾病精准医学北京实验室

英文单位：

关键词：急性心肌炎；左心室射血分数；临床特点

英文关键词：

• 摘要：

• 【摘要】目的    分析入院时左心室射血分数(LVEF)减低的成年急性心肌炎患者的临床特点。方法    回顾性收集2007年1月至2016年12月于首都医科大学附属北京安贞医院住院的80例急性心肌炎患者（年龄大于18岁）的病历资料，男54例、女26例。按入院时超声心动图所示LVEF分为LVEF减低组(LVEF＜50%，20例)和LVEF正常组（LVEF≥50%，60例）。对比分析2组临床特点、治疗及转归等。结果    LVEF减低组的女性比例明显高于，平均年龄明显大于，入院时收缩压明显低于，入院时心率明显快于LVEF正常组［60.0%（12/20）比23.3%（14/60）、（32±12）岁比（26±7）岁、（96±19）mmHg（1 mmHg=0.133 kPa）比（113±16）mmHg、（102±23）次/min比（81±21）次/min］（均P＜0.05）。LVEF减低组的白细胞计数、中性粒细胞计数均明显高于LVEF正常组（均P＜0.05）。LVEF减低组血清丙氨酸转氨酶、肌酐水平均明显高于LVEF正常组（均P＜0.05）。LVEF减低组心电图出现QRS波增宽、严重室性心律失常的比例均明显高于LVEF正常组［50.0%（10/20）比18.3%（11/60）、35.0%（7/20）比10.0%（6/60）］（均P＜0.01）。LVEF减低组使用利尿剂、血管活性药物（多巴胺、去甲肾上腺素、肾上腺素）、糖皮质激素、静脉输注丙种免疫球蛋白、抗菌药物的比例均明显高于LVEF正常组（均P＜0.05）。LVEF减低组使用呼吸机、连续肾脏替代治疗、体外膜肺氧合的比例均明显高于LVEF正常组（均P＜0.05）。LVEF减低组发生急性肾损伤、肝功能异常、心源性休克、多脏器功能衰竭的比例均明显高于LVEF正常组［45.0%（9/20）比5.0%（3/60）、55.0%（11/20）比15.0%（9/60）、35.0%（7/20）比3.3%（2/60）、20.0%（4/20）比0.0%（0/60）］（均P＜0.01）。LVEF减低组的住院期间病死率明显高于，平均住院天数明显多于LVEF正常组［15.0%（3/20）比1.7%（1/60）、（17±12）d比（9±5）d］（均P＜0.05）。结论    入院时LVEF减低的成年急性心肌炎患者病情危重，更多合并了血流动力学异常、恶性心律失常及各种并发症，病死率高，应密切监护及综合治疗。

• 【Abstract】Objective    To investigate the clinical characteristics of acute myocarditis with low left ventricular ejection fraction (LVEF) in adults. Methods    Clinical records of 80 patients(54 males and 26 females, more than 18 years old) with the diagnosis of acute myocarditis were enrolled between January 2007 and December 2016 in Beijing Anzhen Hospital, Capital Medical University. According to the value of LVEF on admission, the patients were divided into low LVEF group(LVEF＜50%, n＝20) and normal LVEF group（LVEF≥50%, n＝60）. Clinical features, treatments and outcomes were analyzed. Results    In the low LVEF group, female ratio and the mean age were higher, systolic pressure was lower and heart rate was higher than those in the normal LVEF group［60.0%（12/20） vs 23.3%（14/60）, （32±12）years vs （26±7）years, （96±19）mmHg vs （113±16）mmHg, （102±23）times/min vs （81±21）times/min］（P＜0.05）. Leukocyte count and neutrophil count in the low LVEF group were higher than those in the normal LVEF group（P＜0.05）. Levels of alanine aminotransferase and creatinine in the low LVEF group were higher than those in the normal LVEF group（P＜0.05）. Electrocardiogram showed that the rates of prolonged QRS duration and severe ventricular arrhythmia in the low LVEF group were higher than those in the normal LVEF group［50.0%（10/20） vs 18.3%（11/60）, 35.0%（7/20） vs 10.0%（6/60）］（P＜0.01）. In treatment, diuretics and vasoactive drugs(dopamine, norepinephrine, adrenaline), glucocorticoids, intravenous immunoglobulin and antibacterials in the low LVEF group were more often used than those in the normal LVEF group（P＜0.05）. Ventilator-assisted breathing, continuous renal replacement therapy and extracorporeal membrane oxygenation were more frequent in the low LVEF group than those in the normal LVEF group（P＜0.05）. Incidences of acute renal injury, liver dysfunction, cardiac shock and multiple organ failure in the low LVEF group were higher than those in the normal LVEF group［45.0%（9/20） vs 5.0%（3/60）, 55.0%（11/20） vs 15.0%（9/60）, 35.0%（7/20） vs 3.3%（2/60）, 20.0%（4/20） vs 0.0%（0/60）］（P＜0.01）. In-hospital mortality rate in the low LVEF group was higher and the mean hospital time was longer than those in the normal LVEF group［15.0%（3/20） vs 1.7%（1/60）, （17±12）d vs （9±5）d］（P＜0.05）. Conclusion    Acute myocarditis with low LVEF is serious in adults; they may have hemodynamic abnormalities, malignant arrhythmia, severe complications and high mortality.