2018 年第 6 期 第 13 卷

心脏磁共振成像检查出现晚期钆增强心肌炎患儿的临床特点和短期预后

Clinical characteristics and short-term prognosis of myocarditis with late gadolinium enhancement in cardiac magnetic resonance imaging in children

作者：杨曦刘桂英

英文作者：

单位：100029首都医科大学附属北京安贞医院儿科

英文单位：

关键词：心肌炎；心脏磁共振；晚期钆增强；危险分层

英文关键词：

• 摘要：

• 【摘要】目的    分析心脏磁共振成像检查出现晚期钆增强（LGE）心肌炎患儿的临床特点和短期预后。方法    收集2012年1月至2017年1月首都医科大学附属北京安贞医院住院治疗的50例心肌炎患儿的临床和影像学资料进行回顾性分析。根据心脏磁共振成像检查是否显示LGE，将所有患儿分为LGE组（14例）和对照组（36例），比较2组患儿的临床资料和随访预后情况。结果    50例心肌炎患儿中，男33例、女27例，年龄5～18岁。患儿的主要症状为胸痛24例（48.0%）、乏力12例（24.0%）、胸闷10例（20.0%）。2组患儿年龄、性别、心电图表现差异无统计学意义（P>0.05）。LGE组肌酸激酶同工酶、心肌肌钙蛋白I水平高于对照组、左心室舒张末期容积大于对照组［（4.7±0.6）μg/L比（4.3±0.3）μg/L、（0.090 0±0.000 3）g/L比（0.070 0±0.000 8）g/L、（48±7）ml比（42±6）ml］，差异均有统计学意义（均P<0.01）。随访期间LGE组不良心血管事件发生率高于对照组［31.2%（5/16）比8.9%（3/34）］，差异有统计学意义（P<0.05）。结论    心脏磁共振成像检查显示LGE的心肌炎患儿基础心肌酶水平高，心功能差，预后不良，LGE检测可用于心肌炎患儿的危险分层。

• 【Abstract】Objective    To analyze clinical characteristics and short-term prognosis of myocarditis with late gadolinium enhancement(LGE) in cardiac magnetic resonance imaging(cMRI) in children. Methods    Imaging records of 50 children with myocarditis in Beijing Anzhen Hospital, Capital Medical University were reviewed from January 2012 to January 2017; LGE in cMRI were observed in 14 children. Clinical data and follow-up data were analyzed between LGE group（n＝14） and control group（n＝36）. Results    There were 33 boys and 27 girls; the age range was 5-18 years; main symptoms included chest pain(n＝24, 48.0%), fatigue(n＝12, 24.0%) and chest distress(n＝10, 20.0%). There were no significant differences of age, sex and electrocardiogram manifestations between groups(P>0.05). Levels of creatine kinase isoenzyme, cardiac troponin I and left ventricular end-diastolic volume in LGE group were significantly higher/larger than those in control group［（4.7±0.6）μg/L vs （4.3±0.3）μg/L, （0.090 0±0.000 3）g/L vs （0.070 0±0.000 8）g/L, （48±7）ml vs （42±6）ml］(P<0.01). Incidence of adverse cardiovascular events in LGE group was significantly higher than that in control group［31.2%（5/16） vs 8.9%（3/34）］(P<0.01). Conclusions    Myocarditis children with LGE in cMRI show increasing level of myocardial enzyme, poor cardiac function and prognosis. Detection of LGE can be used as a tool for risk assessment of myocarditis in children.