成人重症病毒性心肌炎的相关影响因素分析

On influencing factors of severe viral myocarditis in adults

摘要:

目的：探讨成人重症病毒性心肌炎的临床特征及相关影响因素。方法：回顾性分析2015年7月至2019年12月在重庆医科大学附属第一医院心血管内科住院的急性病毒性心肌炎患者93例，根据疾病严重程度分为重症病毒性心肌炎组（重症组）45例和普通病毒性心肌炎组（普通组）48例，比较分析2组一般临床资料及心电图、实验室检查、超声心动图指标，以探索相关影响因素。结果：相较于普通组，重症组收缩压、左室射血分数均降低，丙氨酸氨基转移酶、肌钙蛋白、肌红蛋白均升高，QRS时限、左室收缩末内径均增加，出现ST抬高型心肌损伤、低电压、呼吸困难、晕厥、休克的比例均增高。进一步行多因素logistic回归分析显示，ST抬高型心肌损伤（OR=28.224，95%CI=1.043～763.543，P=0.047）、肌钙蛋白Ⅰ（OR=1.321，95%CI=1.059～1.647，P=0.013）与重症病毒性心肌炎发病的风险增加相关，而收缩压（OR=0.892，95%CI=0.805～0.988，P=0.028）与重症病毒性心肌炎发病的风险降低相关。结论：ST抬高型心肌损伤和肌钙蛋白Ⅰ可能是重症病毒性心肌炎患者的独立危险因素，而收缩压可能是其独立保护因素。

Abstract:

Objective：To investigate the clinical features and the influencing factors of severe viral myocarditis（SVM） in adult patients. Methods：A retrospective analysis was conducted in 93 cases of acute viral myocarditis diagnosed in our hospital from July 2015 to December 2019. These patients were divided into SVM group（n=45），and common viral myocarditis（CVM） group（n=48） according to the severity of the disease. Clinical general baseline characteristics，the parameters of electrocardiogram，laboratory and echocardiogram in the two groups were compared and analyzed to explore the influencing factors. Results：Compared with the CVM group，the systolic blood pressure and left ventricular ejection fraction were decreased，ALT，troponin Ⅰ，myoglobin，QRS duration，left ventricular end systolic diameter were increased，and the proportions of ST-segment elevation myocardial injury，low voltage，dyspnea，syncope，and shock were increased in the SVM group. Multivariate logistic regression analysis showed that ST-segment elevation myocardial injury（OR=28.224，95%CI=1.043-763.543，P=0.047） and troponin Ⅰ（OR=1.321，95%CI=1.059-1.647，P=0.013） were associated with increased risk of the onset of SVM，and the systolic blood pressure（OR=0.892，95%CI=0.805-0.988，P=0.028） was associated with decreased risk of the onset of SVM. Conclusion：ST-segment elevation myocardial injury and troponin Ⅰ may be the independent risk factors of adult patients with SVM，and systolic blood pressure may be an independent protective factor.