【摘要】 目的探讨超声心动图及其多参数评分(EMPS)在重症病毒性心肌炎(VMC)诊疗中的应用价值。方法纳入147例VMC患者,将重症VMC患者作为重症组,其余为非重症组,比较两组的临床资料、超声心动图参数、EMPS及预后;Logistic回归分析重症VMC相关预测因素。结果重症组患者血压较低,心率较快,白细胞计数、中性粒细胞计数、超敏C反应蛋白(hs-CRP)、天冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)、肌钙蛋白I(TnI)、住院天数、急性期死亡率、堪萨斯市心肌病变问卷(KCCQ)显著高于非重症组(P<0.05)。治疗前,两组左室射血分数(LVEF)明显下降,重症组EMPS、室间隔厚度(IVS)、左室后壁厚度(LVPW)大于非重症组,LVEF、左室舒张末期内径(LVDd)小于非重症组,差异均有统计学意义(P均<0.05)。治疗后,两组LVEF均明显提高,EMPS、左室收缩末期内径(LVDs)均显著减小,重症组IVS、LVPW明显缩小,EMPS明显大于非重症组,LVDd明显小于非重症组,差异均有统计学意义(P均<0.05)。EMPS、TnI、心率、收缩压为重症VMC的独立预测因素(P<0.05)。结论超声心动图的表现及EMPS对于早期预警重症VMC具有重要价值,EMPS、TnI、心率、收缩压为重症VMC的独立预测因素。更多还原

【Abstract】 Objective To explore the application value of echocardiography and its multi-parameter score in the diagnosis and treatment of severe viral myocarditis(VMC). Methods 147 patients with VMC were included. Severe VMC was in the severe group and the rest were in the non-severe group. the clinical data, echocardiographic parameters, EMPS and prognosis of the two groups were compared. Logistic regression was used to analyze the predictors of severe VMC. Results The severe group had lower blood pressure and faster heart rate. The white blood cell count, neutrophil count, hypersensitive C-reactive protein(hs-CRP), aspartate aminotransferase(AST), lactate dehydrogenase(LDH), troponin I(TnI), hospital stay, mortality ratein the acute phase and Kansas City Cardiomyopathy Questionnaire(KCCQ) in severe group were significantly higher than those in non-severe group(all P<0.05). Before treatment, the left ventricular ejection fraction(LVEF) in both groups was significantly decreased. The EMPS, interventricular septal thickness(IVS), and left ventricular posterior wall thickness(LVPW) in severe group were greater than those in non-severe group. the LVEF and left ventricular end diastolic diameter(LVDd) in severe group were significantly smaller than those in non-severe group(all P<0.05). After treatment, the LVEF in both groups was significantly increased, the EMPS and LVDs were significantly reduced, the IVS and LVPW in severe group were significantly reduced, the EMPS in severe group was still significantly greater than that in nonsevere group, LVDd in severe group was significantly less than that in non-severe group(all P<0.05). The EMPS, TnI, heart rate and systolic blood pressure were independent predictors of severe VMC(all P<0.05). Conclusion The performance of echocardiography and EMPS are important for early warning of severe VMC. the EMPS, TnI, heart rate and systolic blood pressure are independent predictors of severe VMC.更多还原