Objective: To determine the early recognizable factors related to patients with fulminant myocarditis. Methods: Medical records from 60 adult patients who were diagnosed with acute viral myocarditis from January 2003 to September 2016 in our hospital were retrospectively reviewed, and divided into the fulminant group (n=9) and the non-fulminant group (n=51). Clinical presentations, biochemical markers, electrocardiography and echocardiography features on admission were analyzed. Results: Prevalence of syncope (33.3%(3/9) vs. 2.0% (1/51), P=0.009) and fatigue (77.8% (7/9) vs. 21.6% (11/51) , P=0.002) was significantly higher, while the duration from flu-like syndromes to chest discomfort was shorter ((2.0±1.8) days vs. (4.5±3.5) days, P=0.041) in the fulminant group than that in the non-fulminant group. Systolic blood pressare (SBP) ((94±14) mmHg(1 mmHg=0.133 kPa) vs. (117±12)mmHg, P=0.001) and left ventricular ejection fraction((49±12)% vs. (60±13)%, P=0.016) were significantly lower, while heart rate ((99±20)bpm vs. (84±19)bpm, P=0.040) and NT-proBNP concentration ((7 962 (1 470, 23 849) ng/L vs. 1 771 (45, 2 380) ng/L, P=0.000) were significantly higher in the fulminant group than those in the non-fulminant group. PR interval was longer (199 (140, 416) ms vs. 156 (112, 204) ms, P=0.021), QRS complex was wider ((127±14)ms vs. (95±13)ms, t=-6.647, P<0.001) in the fulminant group than those in the non-fulminant group. Prolonged QRS duration≥120 ms was more often in fulminant group (77.8%(7/9) vs. 5.9%(3/51), P=0.000). Multivariate analysis revealed that PR interval (adjusted odd ratio 1.044, 95%CI 1.005-1.084, P=0.025) and QRS complex width (adjusted odd ratio 1.252, 95%CI 1.045-1.501, P=0.015) were the independent risk factors significantly associated with fulminant myocarditis. Conclusions: The risk of a fulminant course of acute myocarditis is higher in patients with elevated NT-proBNP, reduced left ventricular ejection fraction, and conduction disturbances at admission. Prolonged PR interval and widened QRS complex on admission are independent risk factors for developing fulminant myocarditis in adult patients with acute viral myocarditis.
目的： 探讨早期识别暴发性心肌炎的相关因素。 方法： 回顾性纳入北京大学第三医院心内科2003年1月至2016年9月救治的成人急性病毒性心肌炎患者60例，根据临床诊断分为暴发性心肌炎组（n=9）和非暴发性心肌炎组（n=51）。比较两组患者入院时的症状、生命体征、血液生化学指标、超声心动图参数及心电图表现。并通过二分类logistic回归模型进行多因素分析，探讨早期识别暴发性心肌炎的相关因素。 结果： 暴发性心肌炎组患者乏力和晕厥的发生率均明显高于非暴发性心肌炎组[分别为77.8%（7/9）比21.6%（11/51）（χ(2)=11.509，P=0.002）和33.3%（3/9）比2.0%(1/51)（χ(2)=12.101，P=0.009）]。暴发性心肌炎组患者出现病毒感染样症状到出现心脏不适症状的时间较非暴发性心肌炎组短[（2.0±1.8）d比（4.5±3.5）d，t=2.085，P=0.041]。暴发性心肌炎组患者来诊时的收缩压较非暴发性心肌炎组低[（94±14）mmHg（1 mmHg=0.133 kPa）比（117±12）mmHg，t=5.18，P=0.001]，心率较快[(99±20)次/min比（84±19）次/min，t=-2.096，P=0.04]。暴发性心肌炎组患者N末端B型利钠肽原水平高于非暴发性心肌炎组[7 962（1 470, 23 849）ng/L比1 771（45, 2 380）ng/L, z=-4.068，P=0.000]。暴发性心肌炎组患者左心室射血分数低于非暴发性心肌炎组[（49±12）%比（60±13）%，t=2.473，P=0.016]。暴发性心肌炎组患者PR间期较非暴发性心肌炎组长[199（140，416）ms比156(112，204)ms，z=-2.300，P=0.021]，PR间期>200 ms者比率较高[33.3%（3/9）比3.9%（2/51），χ(2)=6.405，P=0.021]；暴发性心肌炎组患者QRS间期大于非暴发性心肌炎组[(127±14)ms比（95±13）ms，t=-6.647，P<0.001]，QRS间期>120 ms者比率较高[77.8%(7/9)比5.9%(3/51)，χ(2)=28.471，P=0.000]。多因素logistic回归分析结果显示入院时的PR间期（调整的OR=1.044，95%CI 1.005~1.084，P=0.025）和QRS间期（调整的OR=1.252，95%CI 1.045~1.501，P=0.015）是暴发性心肌炎的相关因素。 结论： 急性病毒性心肌炎患者入院时PR间期延长和QRS间期延长是成人暴发性心肌炎的相关因素。.
Keywords: Adult; Forecasting; Myocarditis.