小儿病毒性心肌炎的门控心肌灌注显像研究

目的：研究单光子发射型计算机断层显像（ＳＰＥＣＴ）在小儿病毒性心肌炎中的诊断意义。方法：用９９ｍＴｃ－ＭＩＢＩ观察了４７例临床诊断为病毒性心肌炎患儿的门控及非门控心肌灌注显像，观察了其左室射血分数及室壁运动情况。结果：４７例病毒性心肌炎患儿中４２例（８９％）门控心肌灌注异常，２６例（５５％）非门控心肌灌注异常，门控阳性率明显高于非门控（Ｐ＜００１）。心肌炎组与正常对照组相比，左室射血分数无显著性差异，２８例（５９６％）左室局部室壁运动减弱、不协调。结论：门控心肌灌注显像法能将病变部位、形态、范围和程度较直观地显示出来，图像清晰、敏感度高，可作为小儿病毒性心肌炎的一项重要辅助诊断方法     

核素^99M锝心肌灌注显像技术诊断小儿心肌炎的临床应用

为观察核素^mmM锝心肌灌注显像技术诊断小儿心肌炎的临床应用价值。采用周围血管静脉注射核素^99MTCMIBI,SPECT摄像对28例病毒性心肌炎患儿进行检查。结果：26例阳性,2例阴性。该法在本次调查的病例中敏感性达92.8%（26/28例）,且早期检查阳性率更高。病变部位分布在：左室最多占76.9%,右室次之,心房少见,同时对2例伤寒中毒性心肌炎,1例甲亢及1例植物神经紊乱患儿进行该检查,结果：2例伤寒中毒性心肌炎阳性,其它2例阴性。说明核素^99M锝心肌灌注显像技术在诊断小儿心肌受扣方面是有价值的,但无病原学诊断价值。此法在诊断病毒性心肌炎时应排除其它心脏疾病。可作为疑似心肌炎的辅助诊断检查。     

儿童心肌炎动态心电图监测临床价值探讨

目的：目前诊断病毒性心肌炎的标准仍是采用临床、心脏器械和实验室检查相结合的方法综合判断。该文对儿童心肌炎动态心电图(DCG)监测下心电变化特点作一回顾性分析,旨在为临床诊断、治疗及预后判断提供重要依据。方法：分析59例儿童心肌炎及41例无器质性心脏病对照组的心电图变化,测定DCG异常率、室性早搏数量、级别及分布情况、心率变异指标。 结果：心肌炎组异常DCG检出率86.4%,且部分为复合心律失常,与对照组DGC异常检出率46.3%相比,差异非常显著﹙P<0.01﹚。室早分布类型心肌炎组以均匀型（84.6%﹚及单峰型﹙64.4%﹚最常见,与对照组比较差异有显著性﹙P<0.05,P<0.01﹚。 结论： 儿童DCG监测异常、早搏分布为均匀型、早搏高峰为单峰及多峰型者或出现复合心律失常对儿童心肌炎的诊断、治疗及预后判断有一定参考价值。［中国当代儿科杂志,2007,9（3）：213-215］     

骨髓间充质干细胞对病毒性心肌炎小鼠的干预作用

目的探讨骨髓间充质干细胞(BMSCs)对小鼠病毒性肌炎的作用。方法 4周龄BALB/C雄性小鼠随机分为,正常对照组、心肌炎组、心肌炎不同阶段(3天、2周)BMSCs干预组,腹腔注射柯萨奇病毒B3建立病毒性心肌炎小鼠模型,干预组分别于注射病毒后3天、2周尾静脉注射小鼠BMSCs,4周后行心脏超声检查,光镜观察并计算心肌组织病理积分及胶原容积分数(CVF),q RT-PCR法检测心肌组织匀浆胶原纤维I(col1α1)和胶原纤维III(col3α1)m RNA表达。结果与正常对照组相比,心肌炎组左室前后壁变薄,左室收缩期末期内径和容积增大,左室射血分数(LVEF)及短轴缩短率(FS)降低,差异均有统计学意义(P均0.05);干预组各亚组LVEF及FS较心肌炎组均有改善,其中心肌炎2周时干预组改善更明显,差异均有统计学意义(P均0.05)。光镜下,心肌炎组心肌组织CVF较正常对照组增高,干预组CVF较心肌炎组降低,其中心肌炎2周干预组CVF较心肌炎3天干预组更低,差异均有统计学意义(P均0.05)。与正常对照组相比,心肌炎组col1α1和col3α1 m RNA表达均升高,干预组col1α1和col3α1 m RNA表达较心肌炎组降低,差异均有统计学意义(P均0.05)。结论 BMSCs可减少病毒性肌炎小鼠心脏纤维化程度及改善心功能,且病毒感染2周时干预效果更佳。     

左室假腱索误诊心肌炎3例

１９９８年６月至１９９９年４月,我科收治左室假腱索３例均误诊为病毒性心肌炎。３例中男１例、女２例,年龄４～６岁。３例均因心律不齐,心电图示室性早搏,以病毒性心肌炎收住院。体检心界不大,未闻及杂音,早搏９～２０／ｍｉｎ。查心肌酶谱正常。２４ｈ动态心电图示窦性心律不齐,频发性室性早搏。后经Ｂ超检查,分别于左心腔内右侧壁、左室长轴切面、左室后壁见１６,２４,１７ｍｍ的强回声条索,均诊断为左室假腱索。本文３例说明,凡发现心律不齐,心电图示早搏者,不要轻易作出心肌炎的诊断,应做进一步检查。左室假腱索误诊心…     

19例儿童重症心肌炎诊治体会

目的 探讨儿童重症心肌炎临床特点及治疗方法。方法 对我院2005年1月至2012年1月收治的19例儿童重症心肌炎（重症心肌炎组）发病特点、临床表现、诊治经过及预后进行回顾性分析,选择同期在我院体检的正常健康儿童23例为对照组。采用ELISA法检测心肌肌钙蛋白（cardiac troponin,CTn）-Ⅰ及血清氨基末端脑利钠肽前体（N-terminal pro-brain natriuretic peptide,NT-proBNP）水平,应用彩色多普勒超声心动图检查了解左室射血分数和左室短轴缩短率变化。结果 重症心肌炎组患儿CTn-Ⅰ为（18.67 ±12.31） ng/ml,显著高于正常对照组[（0.02 ±0.01） ng/ml],差异有统计学意义（P＜0.05）。与急性期相比,病程第7天CTn-Ⅰ为（0.55±0.24） ng/ml,呈逐渐下降趋势,第14天基本接近正常[（0.06±0.03） ng/ml],差异有统计学意义（P＜0.05）。重症心肌炎组NT-proBNP较对照组明显增高[（3 067.26 ±902.79） pg/ml vs （80.04±17.79） pg/ml,P＜0.05]。与急性期相比,病程第7天NT-proBNP为（648.63±342.37） pg/ml,病程第14天基本接近正常[（213.58±129.51） pg/ml]（P＜0.05）。重症心肌炎组患儿左室射血分数[（52.63±6.98）％vs（71.39±2.41）％]及左室短轴缩短率[（32.1±2.97）％vs（40.04±2.31）％]明显低于正常对照组,差异均有统计学意义（P均＜0.05）。结论 儿童重症心肌炎起病急,病情重,病死率高,在综合治疗基础上早期应用肾上腺素皮质激素和丙种球蛋白,必要时安装临时起搏器,可改善预后。     

疑似病毒性心肌炎患儿频发房性期前收缩41例近期随访研究

目的 探讨疑似病毒性心肌炎患儿频发房性期前收缩的特点及近期预后。方法 收集郑州大学第一附属医院儿科10年来收治的以频发房性期前收缩为主要临床表现的41例疑似病毒性心肌炎患儿临床资料,回顾性分析其动态心电图特点及房性期前收缩的近期预后,并探讨两者的关系。 结果 （1）30例（73%）全天房性期前收缩总数小于20000,4例（10%）为房性并行心律, 35例（85%）心房异位P'波可提前至T波, 14例（32%）合并房性心动过速,多数病例为单源性期前收缩、 起源于心房下部。（2）给予2周抗病毒、 营养心肌、 抗氧化及中成药治疗后, 半数患儿房性期前收缩减少超过30%。（3）合并房性心动过速者比单纯频发房性期前收缩者近期预后好（P < 0.05）。结论 疑似病毒性心肌炎儿童的频发房性期前收缩,尤其是合并房性心动过速者,多为病毒性心肌炎引起,按病毒性心肌炎治疗可使期前收缩减少或消失。     

三尖瓣环收缩期位移在婴幼儿高原性心脏病右心功能评估中的应用

目的　探讨三尖瓣环收缩期位移对高原性心脏病婴幼儿的右心室功能的价值。方法　2017年8月至2018年8月间到西藏自治区人民医院儿科住院的临床诊断为高原性心脏病的患儿21例，根据患儿心功能改良ROSS评分，将患儿分为轻中度心衰组（13例）及重度心衰组（8例），同期来自上述地区因心脏杂音行超声心动图检查的健康婴幼儿（14例）作为对照组。超声常规测量右心室横径，右心室前壁厚度，三尖瓣返流最大返流速度，下腔静脉吸气塌陷率，及应用M型超声测量右心室游离壁三尖瓣环收缩期位移（TAPSE）。采用酶联免疫法测定患儿的血清脑钠肽浓度。结果　（1）与正常对照组相比，高原性心脏病组患儿右室流出道内径显著增大，右心室前壁厚度显著增厚，差异均有统计学意义（P＜0.05）；高原性心脏病患儿的TAPSE则显著低于对照组婴幼儿，差异均有统计学意义（P＜0.05）；（2）与轻中度心衰婴幼儿相比较，重度心衰患儿的右室流出道内径，右心室前壁厚度及肺动脉压力差异无统计学意义（P＞0.05），但血清BNP浓度在重度心衰的患儿显著高于轻中度心衰患儿，差异具有统计学意义（P＜0.05），而TAPSE 在重度心衰患儿则显著低于轻中度心衰患儿，具有统计学意义（P＜0.05）；（3）采用spearman相关分析发现，TAPSE与婴幼儿心力衰竭ROSS评分、PASP及BNP均呈较好的负相关，相关系数r值分别为-0.517、-0.718及-0.749，P值均＜0.05。结论　TAPSE可作为临床评价高原性心脏病婴幼儿的右心室功能提供一个简单、可操作性强、可重复性好的新方法。为协助诊断及评估高原性心脏病患儿的严重程度具有重要意义。     

急性病毒性心肌炎患儿肌钙蛋白T测定的临床意义

目的　探讨急性病毒性心肌炎患儿血清心脏肌钙蛋白Ｔ（ＣＴｎＴ）的临床意义。方法　４０ 例急性病毒性心肌炎患儿进行酶免法测定血清ＣＴｎＴ,同时测定心肌酶谱ＣＫ、ＣＫ－ＭＢ、ＬＤＨ等,２ｗ ｋ 后复检。结果　４０ 例急性病毒性心肌炎患儿血清ＣＴｎＴ浓度治疗前较治疗后明显升高,与正常对照组比较有显著差异（Ｐ＜ ０．０１）。与心肌酶谱对照,血清ＣＴｎＴ较ＣＫ－ＭＢ的增高率明显,持续时间长。结论　急性病毒性心肌炎患儿血清ＣＴｎＴ明显升高,提示心肌受累,其特异性高于ＣＫ－ＭＢ。持续增高可提示预后不良,应结合ＥＫＧ变化,进一步加强心肌保护性治疗措施。     

声学密度技术定量评价缺氧肺动脉高压对左室心肌损伤的实验研究(英文)

目的：探讨声学密度定量(AD)技术定量评价缺氧肺动脉高压(PH)后左室心肌损害的应用价值。方法：在建立缺氧肺动脉高压兔模型的基础上，应用AD技术对PH组和正常对照组兔左室相应部位心肌密度值进行测定。结果：与正常组比较，缺氧PH组左室前壁的背向散射强度标准差(SDI)及背向散射强度周期性变化幅度(CVIB)差异无统计学意义(P>0.05)，但心动周期背向散射强度平均值(AII)明显升高(P<0.05)；室间隔中部CVIB明显减低(P<0.05)，AII明显升高(P<0.05)；左室后壁AII明显升高(P<0.05)。PH组左室心肌不同部位AII值与左室舒张未压(LVDEP)成正相关(r=0.6206～0.6311，P<0.01)。结论：AD技术对判定缺氧PH后左室心肌损伤改变较为客观、简便，有较高的应用价值。     

Circulating cardiac troponins levels and cardiac dysfunction in children with acute and fulminant viral myocarditis

Objectives: To study the correlation between cardiac Troponins blood levels and degrees of cardiac dysfunction in children with acute and fulminant viral myocarditis and to study their prognostic role in predicting the outcomes and risk of having dilated cardiomyopathy. Methodology: Troponin I & T blood levels were measured in 65 children with acute or fulminant viral myocarditis. The cardiac functions of RV & LV were assessed by Doppler echocardiography. Results: The levels of cTnI & CTnT were significantly higher in patients with fulminant myocarditis than in controls and children with acute myocarditis (p < 0.05 & <0.001* respectively). The cardiac functions were significantly impaired in fulminant myocarditis than in acute myocarditis (p < 0.001*). There were negative correlations between the cardiac troponins levels and the cardiac functions measured by echocardiography in children with acute and fulminant myocarditis. There were 3 deaths (7.5%), and 10 (25%) children developed dilated cardiomyopathy in acute myocarditis while there were eight deaths (32%) and one patient (4%) who developed dilated cardiomyopathy in fulminant myocarditis group. Conclusion: Cardiac troponins levels can predict the severity of myocarditis and the prognosis on the short‐term level. Fulminant myocarditis was associated with higher levels of both cTn I & cTn T than acute myocarditis. Despite that fulminant myocarditis has a more aggressive course, the risk of developing cardiomyopathy was less than in acute myocarditis.     

The Forgotten Chamber: Right-Ventricular Functions in Juvenile Idiopathic Arthritis

Cardiac involvement, such as pericarditis, myocarditis, and endocarditis, is seen in juvenile idiopathic arthritis. Although there have been some reports about right-ventricular systolic and diastolic functions of adults with rheumatoid arthritis and left-ventricular systolic and diastolic functions of children with JIA, there have been no studies about RV functions of children with JIA. The aim of this study was to determine RV functions in children with JIA. We performed conventional echocardiography and tissue Doppler imaging measurements of the right ventricle of patients with JIA. All patients were in sinus rhythm at the time of examination without overt LV heart failure and with normal LV ejection fraction. Fifty-five children with the diagnosis of JIA and 33 healthy control subjects were included in the study. Peak systolic, early, and late diastolic tricuspid annular velocities were significantly decreased in JIA patients compared with healthy controls (p < 0.05). Isovolumic accelaration (IVA), as a measure of myocardial acceleration during isovolumic contraction of the right ventricle, was also significantly lower in JIA patients than in healthy controls (p < 0.05). RV systolic and diastolic functions, in addition to the previously shown LV functions, are affected in JIA patients. IVA decreases in JIA patients and may be used as an alternative, noninvasive parameter for the assessment of RV systolic function in children with JIA.     

Anterosuperior Diverticula of the Right Ventricle: Morphological Spectrum and Long-Term Outcome of a Distinct Cardiac Anomaly

Right-ventricular diverticula (RVD), although rare, have particular characteristics. Our study describes the morphology of anterosuperior diverticula of the right ventricle (RV) and patient outcome for this anomaly. Retrospective analysis was performed on all patients with anterosuperior RVD diagnosed in two tertiary referral centres. From January 1982 to December 2012, five patients were diagnosed with anterosuperior RVD (median 4 months). Four patients had perimembranous ventricular septal defects (VSDs) with no clinical symptoms related to RVD. Communication of the RVD with the RV was located either close to the VSD (two patients) or in the anterior free wall of the RV opposite the VSD (two patients). In the remaining patient, the diverticulum was connected with the left ventricle (LV) by a tunnel-like structure originating from the left-ventricular outflow tract; the RVD communicated with the RV by way of a restrictive opening. Four patients underwent surgical repair including patch closure of the VSD (one patient) and patch closure of the VSD through an incision of the RVD followed by plication of the diverticulum or closure of its communication with the RV (three patients). All patients remained asymptomatic during a median follow-up of 14.8 years. Anterosuperior RVD is a specific congenital cardiovascular anomaly frequently associated with additional congenital heart disease. There are significant variations in how the RVD communicates with the RV with each requiring a different surgical repair strategy. According to the experience in our small cohort, the long-term prognosis of patients with anterosuperior RVD appears excellent after surgical correction of associated congenital heart disease.     

Arrhythmogenic right ventricular dysplasia in brother and sister: Is it related to myocarditis?

Summary Two cases of arrhythmogenic right ventricular dysplasia (ARVD) in siblings are reported. In the boy, 14 years old, the clinical history, ECG, echocardiography, and histopathological findings were consistent with ARVD. Premature ventricular contractions of left bundle branch block (LBBB) pattern were recorded but no ventricular tachycardia (VT). A high titer against mycoplasma and increased concentrations of immunoglobulins were found. Two years after his first admission he died suddenly. Autopsy revealed severe right ventricular (RV) myocardial damage, with fat cell infiltration and collagenous tissue. His sister presented with sustained VT of LBBB pattern 2 years later, at 12 years of age. Vaccination against rubella and signs of upper respiratory illness had preceded the symptoms. During the following 9 days ECGs and serum enzymes indicated the development of left ventricular (LV) infarction. Echocardiography revealed an enlarged RV and a normal LV. After 6 weeks both RV and LV showed akinetic areas and sacculations. We suggest that myocarditis may be a precipitating factor in ARVD, and perhaps the prerequisite for its manifestation.     

超声心动图评价心力衰竭患儿左、右心舒张功能

目的　探讨充血性心力衰竭（ＣＨＦ）患儿左、右心舒张功能及其相互关系。方法　对５１ 例ＣＨＦ患儿和６０ 例正常对照儿童用多普勒超声心动图测量左、右室充盈参数。结果　与正常对照组比较,ＣＨＦ组患儿左、右室充盈参数均显示舒张受损,且左、右室充盈参数呈良好相关。结论　ＣＨＦ组患儿均存在左、右心舒张功能障碍,且程度类型相似     

Right Ventricle Myocardial Perfusion Scintigraphy: Feasibility and Expected Values in Children

Stress myocardial perfusion scintigraphy imaging (SMPSI) has important applications for evaluating coronary disease and ventricular function. Studies consistently focus on the left ventricle (LV), with no normal right ventricle (RV) data available. This study sought to evaluate the feasibility of RV perfusion with technetium (Tc-99m) sestamibi using a low radiotracer dose for children free of coronary artery (CA) anomalies and to determine its normal pattern. Patients with a history of Kawasaki disease who showed no coronary complications on selective angiography or no LV perfusion defects on SMPSI were studied at rest and during an exercise challenge. The RV uptake counts were compared with those for different segments of the LV, and multiple ratios of the uptakes between RV and LV segments were calculated. The study subjects were 23 children (age, 11.1 ± 3.3 years) imaged with 0.12 ± 0.03 mCi/kg at rest and 0.31 ± 0.06 mCi/kg during stress. The RV to LV uptake proportion was approximately 6%. Exercise-related uptake increased threefold in both the RV and the LV. The findings showed RV myocardial scintigraphy to be feasible with reproducible ratios. Potential clinical applications include acquired and congenital CA anomalies such as Kawasaki disease, right CA ostium stenosis after a switch operation, and anomalous origin of the right CA.     

血清心脏肌钙蛋白I对小儿病毒性心肌炎诊断和转归监测价值

目的：评价心脏肌钙蛋白I(cTnI)对小儿病毒性心肌炎的诊断价值,探讨其与肌酸激酶同功酶(CK-MB)以及病毒性心肌炎的病程、病情演变等之间的关系。方法：采用免疫层析法和速率法测定38例病毒性心肌炎和24例非心肌炎患儿血清cTnI,CK-MB。间接ELISA法测定柯萨基病毒B1-6IgM(CVB1-6-IgM)。结果：病毒性心肌炎患儿血清cTnI和CK-MB阳性率分别为 89.5%,60.5%,明显高于非心肌炎组(8.3%,29.2%)和对照组(0)(P<0.05)。82.4% 的血清cTnI阳性出现在病程1周以内。CVB 1-6 IgM阳性与阴性组的cTnI和CK-MB阳性率差异无显著性。结论：血清cTnI反映心肌细胞损害的敏感性和特异性均高于CK-MB,有较宽的诊断时间窗,是一项极具临床价值的心肌炎诊断和转归监测新指标。     

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??Abstract?? Objective To investigate the features and short-term prognosis of the frequent atrial premature contraction in suspected viral myocarditis children. Methods We collected 41 suspected viral myocarditis patients admitted by the Pediatric Department of our hospital during the latest 10 years, whose main manifestations were frequent atrial premature contraction??and then analysed their Holter??short-term prognosis and the relationship between the two. Results ??1??There were 30 cases ??73%?? whose total atrial premature contractions in the Holter were below 20000??4 cases ??10%?? were atrial pararrhythmia??35 cases ??85%?? with the atrial ectopic P’ wave merged into T wave??14 cases ??32%?? coexisted with atrial tachycardia??most premature contractions were monophyletic and originated from the lower part of the atria. ??2??After 2 weeks of antivirus??myocardial nutrition??antioxidant treatment and traditional Chinese medicine therapy??the premature contraction decreased more than 30% in half of the patients. ??3??The premature contraction decreased more remarkably in patients with atrial tachycardia than those with pure atrial premature contraction. Conclusion For the frequent atrial premature contraction in suspected viral myocarditis children??especially for those coexisted with atrial tachycardia??the most common reason is viral myocarditis??and the atrial premature contranction could decrease or disappear after treatment based on this diagnosis.     

Early predictors of myocardial disease in children and adolescents with type 1 diabetes mellitus

Background: The spectrum of diabetic heart disease involves a progression from normal heart to preclinical left ventricular diastolic and systolic dysfunction followed by overt echocardiographic evidence of left ventricular (LV) dysfunction and finally symptomatic heart failure. Objective: To compare the value of tissue Doppler imaging (TDI) over the conventional echocardiography in the assessment of early myocardial dysfunction in type 1 diabetics in correlation with serum N‐terminal pro‐brain natriuretic peptide (NT‐pro‐BNP), state of metabolic control, and diabetes duration. Methods: Sixty subjects were included; 40 type 1 diabetics (aged 12–18 years). Twenty matched subjects served as controls. They were subjected to clinical examination with assessment of cardiovascular reflexes for autonomic neuropathy. Laboratory investigations included mean random blood sugar (MRBS), hemoglobin A1c (HbA1c), urinary microalbumin, and serum determination of NT‐pro‐BNP. Echocardiography for chamber dimensions, systolic and diastolic function, Tie index, and longitudinal myocardial global biventricular function by pulsed TDI of 6 LV walls and right ventricle (RV) free wall. Results: All diabetics and controls had normal LV dimensions, LV mass index and systolic functions except for higher left ventricular posterior wall (LVPW) in diabetics (P < 0.05). LV and RV diastolic dysfunction diagnosed in 25% of diabetics by conventional Doppler with higher peak A (P < 0.05, P < 0.05) and lower E/A (P < 0.05, P < 0.05) compared to controls. Diabetics had larger Tie index (P < 0.05). TDI showed delayed myocardial relaxation in 52.5% of diabetics with lower LV and RV peak Em (P < 0.05, P < 0.01) and Em/Am (P < 0.01, P < 0.001) compared to controls. NT‐pro‐BNP was elevated in diabetics (P < 0.01) with best cut‐off value = 62.5 Fmol/mL, sensitivity (82%), and specificity (95%) for detection of isolated diastolic dysfunction in diabetics. It was correlated negatively with LV Em (P < 0.05), Em/Am (P < 0.01) and positively with Am (P < 0.01), impaired diastolic velocities were associated with higher HbA1c. Conclusion: Asymptomatic diabetics had evidence of subtle right and LV dysfunction with delayed myocardial relaxation which was related to metabolic control. Tissue Doppler (TD) has an additional value in evaluating ventricular filling. NT‐pro‐BNP is considered a sensitive, specific, and predictive marker for diastolic dysfunction.