心肌炎的诊断与治疗

吴琳琳, 韩波

中国当代儿科杂志 ›› 2014, Vol. 16 ›› Issue (12) : 1283-1288.

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中国当代儿科杂志 ›› 2014, Vol. 16 ›› Issue (12) : 1283-1288. DOI: 10.7499/j.issn.1008-8830.2014.12.022
综述

心肌炎的诊断与治疗

  • 吴琳琳, 韩波
作者信息 +

Diagnosis and treatment of myocarditis

  • WU Lin-Lin, HAN Bo
Author information +
文章历史 +

摘要

心肌炎是指心肌的局限性或弥漫性的炎性病变为主要表现的疾病.近年来随着对心肌炎动物模型实验研究及患者临床数据研究的不断深入,在心肌炎诊治方面出现了一些新进展.无创性心脏磁共振检查对心肌炎的的诊断有重大的价值,但不能替代心内膜心肌组织活检.心肌炎的治疗主要是对症辅助支持处理,主要为积极治疗休克、心力衰竭及心律失常等综合治疗,尤其是暴发性心肌炎患者的治疗.因目前缺乏大量的相关临床研究数据,对于心肌炎的诊治仍需进一步探索.

Abstract

Myocarditis is a focal or diffuse inflammatory process of the myocardium. Along with the deepening of research, there are new technological advances which are useful to the diagnosis and treatment of myocarditis. Cardiovascular magnetic resonance imaging has become a useful noninvasive imaging tool for diagnosis of myocarditis, but does not replace endomyocardial biopsy. The supportive treatment has remained the mainstay of therapy for patients with myocarditis, especially with fulminant myocarditis, including the comprehensive treatment of shock, heart failure, and arrhythmia. Due to the lack of large clinical data, diagnosis and treatment for myocarditis remains to be further explored.

关键词

心肌炎 / 心血管疾病 / 诊断与治疗

Key words

Myocarditis / Cardiovascular disease / Diagnosis and treatment

引用本文

导出引用
吴琳琳, 韩波. 心肌炎的诊断与治疗[J]. 中国当代儿科杂志. 2014, 16(12): 1283-1288 https://doi.org/10.7499/j.issn.1008-8830.2014.12.022
WU Lin-Lin, HAN Bo. Diagnosis and treatment of myocarditis[J]. Chinese Journal of Contemporary Pediatrics. 2014, 16(12): 1283-1288 https://doi.org/10.7499/j.issn.1008-8830.2014.12.022

参考文献

[1] CanTer CE, Cunningham MW, Cooper LT. RecenT clinical and TranslaTional research on pediaTric myocardiTis[J]. Prog PediaTr Cardiol, 2011, 32(1): 15-18.
[2] Lieberman EB, HuTchins GM, HerskowiTz A, eT al. ClinicopaThologic descripTion of myocardiTis[J]. J Am Coll Cardiol, 1991, 18(7): 1671-1626.
[3] Camargo PR, Okay TS, YamamoTo L, eT al. MyocardiTis in children and deTecTion of viruses in myocardial Tissue:ImplicaTions for immunosuppressive Therapy[J]. InT J Cardiol, 2011, 148(2): 204-208.
[4] Klugman D, Berger JT, Sable CA, eT al. PediaTric paTienTs hospiTalized wiTh myocardiTis: a mulTi-insTiTuTional analysis[J]. PediaTr Cardiol, 2010, 31(2): 222-228.
[5] Richardson P, McKenna W, BrisTow M, eT al. ReporT of The 1995 World HealTh OrganizaTion/InTernaTional SocieTy and FederaTion of Cardiology Task Force on The DefiniTion and ClassificaTion of CardiomyopaThies[J]. CirculaTion, 1996, 93(5): 841-842.
[6] Caforio ALP, PankuweiT S, ArbusTini E, eT al. CurrenT sTaTe of knowledge on aeTiology, diagnosis, managemenT, and Therapy of myocardiTis:a posiTion sTaTemenT of The European SocieTy of Cardiology Working Group on Myocardial and Pericardial Diseases[J]. Eur HearT J, 2013, 34(33): 2636-2648.
[7] 中华医学会儿科学会心血管组. 病毒性心肌炎诊断标准[J]. 中华儿科杂志, 2000, 38(2): 75-76.
[8] Cooper LT Jr. MyocardiTis[J]. N Engl J Med, 2009, 360:1526-1538.
[9] SmiTh SC, Ladenson JH, Mason JW, eT al. ElevaTions of cardiac Troponin I associaTed wiTh myocardiTis. ExperimenTal and clinical correlaTes[J]. CirculaTion, 1997, 95(1): 163-168.
[10] Soongswang J, DurongpisiTkul K, Nana A, eT al. Cardiac Troponin T: a marker in The diagnosis of acuTe myocardiTis in children[J]. PediaTr Cardiol, 2005, 26(1): 45-49.
[11] Mlczoch E, Darbandi-Mesri F, Luckner D, eT al. NT-pro BNP in acuTe childhood myocardiTis[J]. J PediaTr, 2012, 160(1): 178-179.
[12] Arya SC, Agarwal N. CommenT on: FulminanT myocardiTis and viral infecTion[J]. J Clin Viral, 2013, 58(4): 752.
[13] Daniel RA, Silva AR, Neppelenbroek VB, eT al. FulminanT myocardiTis and viral infecTion[J]. J Clin Virol, 2013, 58(1): 1-3.
[14] Ukena C, Mahfoud F, Kindermann I, eT al. PrognosTic elecTrocardiographic parameTers in paTienTs wiTh suspecTed myocadiTis[J]. Eur J Hear Fail, 2011, 13(4): 398-405.
[15] 杜国军, 许永刚, 李秀昕. QRS波群时限延长在心力衰竭中的临床意义[J]. 中国临床医生, 2010, 38(11): 28-30.
[16] 杨希晨, 王凤鸣, 秦玉明, 等. 小儿暴发性心肌炎危险因素分析[J]. 中国当代儿科杂志, 2009, 11(8): 627-630.
[17] 王小亭, 刘大为. 重视心脏多普勒超声在重症医学领域中的应用[J]. 中华内科杂志, 2011, 50(7): 539.
[18] 张辉, 卢新政. 心肌炎的研究进展[J]. 国际心血管病杂志, 2013, 40(2): 103-107.
[19] Childs H, Friedrich MG. Cardiovascular magneTic resonance imaging in myocardiTis[J]. Pro Cardiovasc Dis, 2011, 54(3): 266-275.
[20] Jorge C, SargenTol L, GaTo Varela M, eT al. TakoTsubo syydrome or acuTe myocardiTis? The role of cardiac magneTic resonance imaging[J]. Rev PorT Cardiol, 2012, 31(9): 609-613.
[21] Friedrich MG, SechTem U, Schulz-Menger J, eT al. Cardiovascular magneTic resonance in myocardiTis: a JACC WhiTe Paper[J]. J Am Coll Cardiol, 2009, 53(17): 1475-1487.
[22] MewTon N, Liu CY, Croisille P, eT al. AssessmenT of myocardial fibrosis wiTh cardiovascular magneTic resonance[J]. J Am Coll Cardiol, 2011, 57(8): 891-903.
[23] Zhao SH. RecommendaTions for CMR in adulTs wiTh CHD from The respecTive working groups of The ESC: explanaTion and viewpoinT[J]. Chin J Magn Reson Imaging, 2010, 1(4): 241-245.
[24] AreTz HT. MyocardiTis: The Dallas criTeria[J]. Hum PaThol, 1987, 18(6): 619-624.
[25] Kindermann I, BarTh C, Mahfoud F, eT al. UpdaTe on myocardiTis[J]. J Am Coll Cardiol, 2012, 59(9): 779-792.
[26] Yilmaz A, Kindermann I, Kindermann M, eT al. ComparaTive evaluaTion of lefT and righT venTricular endomyocardial biopsy: differences in complicaTion raTe and diagnosTic performance[J]. CirculaTion, 2010, 122(9): 900-909.
[27] CaTena E, Paino R, Milazzo F, eT al. Mechanical circulaTory supporT for paTienTs wiTh fulminanT myocardiTis: The role of chocardiography To address diagnosis, choice of device, managemenT, and recovery[J]. J CardioThorac Vasc AnesTh, 2009, 23(1): 87-94.
[28] Mirabel M, LuyT CE, Leprince P, eT al. OuTcomes, long-Term qualiTy of life, and psychologic assessmenT of fulminanT myocardiTis paTienTs rescued by mechanical circulaTory supporT[J]. CriT Care Med, 2011, 39(5): 1029-1035.
[29] Rajagopal SK, Almond CS, Laussen PC, eT al. ExTracorporeal membrane oxygenaTion for The supporT of infanTs, children, and young adulTs wiTh acuTe myocardiTis: a review of The ExTracorporeal Life SupporT OrganizaTion RegisTry[J]. CriT Care Med, 2010, 38(2): 382-387.
[30] European HearT RhyThm AssociaTion, HearT RhyThm SocieTy, Zipes DP, eT al. ACC/AHA/ESC 2006 guidelines for managemenT of paTienTs wiTh venTricular arrhyThmias and The prevenTion of sudden cardiac deaTh: a reporT of The American College of Cardiology/American HearT AssociaTion Task Force and The European SocieTy of Cardiology CommiTTee for PracTice Guidelines (WriTing CommiTTee To Develop Guidelines for ManagemenT of PaTienTs WiTh VenTricular ArrhyThmias and The PrevenTion of Sudden Cardiac DeaTh)[J]. J Am Coll Cardiol, 2006, 48(5): 247-346.
[31] WilmoT I, Price JF, Morales DLS, eT al. EffecTiveness of mechanical circulaTory supporT in children wiTh acuTe fulminanT and persisTenT myocardiTis[J]. J Card Fail, 2011, 17(6): 487-493.
[32] Amabile N, Fraisse A, BouvenoT J, eT al. OuTcome of acuTe fulminanT myocardiTis in children[J]. HearT (BriTish Cardiac SocieTy), 2006, 92(9): 1269-1273.
[33] 王颖, 袁越, 王勤, 等. 暴发性心肌炎71例临床特点分析[J]. 中国循证心血管医学杂志, 2013, 5(6): 643-644.
[34] 董瑞庆, 杨俊华. 心肌炎的诊断与治疗现状[J]. 新医学, 2011, 42(2): 71-74.
[35] Doesch AO, KonsTandin M, Celik S, eT al. EffecTs of proTein A immunoadsorpTion in paTienTs wiTh advanced chronic dilaTed cardiomyopaThy[J]. J Clin Apher, 2009, 24(4): 141-149.
[36] Wang YX, Da CH, VinceleTTe J, eT al. AnTiviral and myocyTe proTecTive effecTs of murine inTerferon-beTa and-{alpha}2 in coxsackievirus B3-induced myocardiTis and epicardiTis in Balb/c mice[J]. Am J Physiol, 2007, 293(1): H69-76.
[37] 伊迎春, 韩波, 朱梅, 等. 小儿暴发性心肌炎22例[J]. 实用儿科临床杂志, 2010, 25(13): 971-973.
[38] Piepoli MF, Guazzi M, Boriani G, eT al. Exercise inTolerance in chronic hearT failure: mechanisms and Therapies. ParT I[J]. Eur J Cardiovasc Prev Rehabil, 2010, 17(6): 637-642.
[39] BlauweT LA, Cooper LT. MyocardiTis[J]. Prog Cardiovasc Dis, 2010, 52(4): 274-288.
[40] Singh TP, Rabah R, Cooper LT, eT al. ToTal lymphoid irradiaTion:new TherapeuTic opTion for refracTory gianT cell myocardiTis[J]. J HearT Lung TransplanT, 2004, 23(4): 492-495.
[41] Nishii M, InomaTa T, Takehana H, eT al. Serum levels of inTerlukin-10 on admission as a prognosTic predicTor of human fulminanT myocardiTis[J]. J Am Coll Cardiol, 2004, 44(6): 1292-1297.
[42] Mason JW, O'Connell JB, HerskowiTz A, eT al. A clinical Trial of immunosuppressive Therapy for myocardiTis. The MyocardiTis TreaTmenT Trial InvesTigaTors[J]. N Engl J Med, 1995, 333(5): 269-275.
[43] D'Ambrosio A, PaTTi G, Manzoli A, eT al. The faTe of acuTe myocardiTis beTween sponTaneous improvemenT and evoluTion To dilaTed cardiomyopaThy: a review[J]. HearT, 2001, 85(5): 499-504.

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