2020 年第 1 期 第 15 卷

成人暴发性心肌炎患者住院期间死亡的影响因素分析

Risk factors of death during hospitalization in adult patients with fulminant myocarditis

作者：赵晗刘文娴任燕龙宁尚秋何卫红

英文作者：

单位：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100029

英文单位：

关键词：暴发性心肌炎；院内死亡；危险因素

英文关键词：

• 摘要：

• 【摘要】目的    分析成人暴发性心肌炎患者住院期间发生死亡的影响因素，为临床诊疗提供参考。方法    回顾性收集2007年1月至2017年12月于首都医科大学附属北京安贞医院住院的年龄大于18岁的50例暴发性心肌炎患者的病历资料。按照住院期间是否发生死亡将患者分为死亡组（7例）和生存组（43例），比较组间临床资料差异，分析患者死亡的影响因素。结果    死亡组患者年龄和女性比例明显高于生存组［45(35,55)岁比27(21,34)岁、6/7比18/43］，入院时收缩压明显低于生存组［（83±13）mmHg(1 mmHg=0.133 kPa)比（101±19）mmHg］，差异均有统计学意义（均P＜0.05）。死亡组血红蛋白水平明显低于生存组［（112±26）g/L比（134±18）g/L］，肌钙蛋白I峰值、肌酸激酶同工酶峰值、D-二聚体水平明显高于生存组［102(67,102)μg/L比16(6,47)μg/L、171(101,268)μg/L比61(14,116)μg/L、5 583(558,16 979)μg/L比408(173,1 769)μg/L］，差异均有统计学意义（均P＜0.05）。死亡组QRS波峰值宽度明显大于生存组［172(146,200)ms比138(102,158)ms］，出现心室扑动/心室颤动的比例明显高于生存组（4/7比3/43），差异均有统计学意义（均P＜0.05）。死亡组使用血管活性药物、呼吸机、主动脉内球囊反搏的比例明显高于生存组（7/7比24/43、7/7比7/43、3/7比3/43），差异均有统计学意义（均P＜0.05）。使用受试者工作特征曲线分析QRS波峰值宽度对患者住院期间发生死亡的预测价值，曲线下面积＝0.761，标准误＝0.081，P＝0.028，95%置信区间为0.603～0.919；以QRS＝145 ms为截断值时，预测住院期间发生死亡的敏感度为85.7%，特异度为60.5%。结论    成人暴发性心肌炎患者中，女性患者住院死亡率较高，QRS波峰值宽度对患者住院期间发生死亡具有预测价值。

• 【Abstract】Objective    To analyze the risk factors of death during hospitalization in adult patients with fulminant myocarditis. Methods    Clinical data of 50 patients over 18 years old with fulminant myocarditis hospitalized in Beijing Anzhen Hospital, Capital Medical University between January 2007 and December 2017 were retrospectively analyzed. The patients were divided into in-hospital death group(7 cases) and survival group(43 cases). Influence factors of death were analyzed. Results    Compared with survival group, patients in death group were older［45(35,55)years vs 27(21,34)years］, the proportion of women was higher［6/7 vs 18/43］, systolic blood pressure on admission was lower［（83±13）mmHg vs （101±19）mmHg］（all P＜0.05）. Hemoglobin level in death group was significantly lower than that in survival group［（112±26）g/L vs （134±18）g/L］; the peak value of troponin I, the peak value of creatine kinase isoenzyme and D-dimer level in death group were significantly higher than those in survival group［102(67,102)μg/L vs 16(6,47)μg/L; 171(101,268)μg/L vs 61(14,116)μg/L; 5 583(558,16 979)μg/L vs 408(173,1 769)μg/L］（all P＜0.05）. In death group there were wilder QRS wave at peak［172(146,200)ms vs 138(102,158)ms］, higher incidence of ventricular flutter or ventricular fibrillation（4/7 vs 3/43）, higher use rates of vasoactive drugs, ventilator and intra-aortic balloon counterpulsation（7/7 vs 24/43, 7/7 vs 7/43, 3/7 vs 3/43） as compared with survival group（all P＜0.05）. Predictive value of peak QRS wave width for death during hospitalization was analyzed using receiver operating characteristic curve, showing that the area under curve was 0.761, standard error was 0.081, P＝0.028, 95% confidence interval was 0.603-0.919; when QRS＝145 ms was taken as cut off value, the sensitivity and specificity in predicting death during hospitalization were 85.7% and 60.5%, respectively. Conclusions    Among adult patients with fulminant myocarditis, female patients are associated with high mortality during hospitalization; peak QRS wave width shows certain predictive value for in-hospital death.