病毒性心肌炎诊断现状与策略

病毒性心肌炎（VMC）患者早期的临床表现、体征及实验室检查结果均缺乏特异性，因而确诊相当困难，国际上尚无统一的标准。VMC的过度诊断难以避免，但因漏诊导致的失治误治，临床上也屡见不鲜。通过复习文献和结合临床研究，提出了以下诊断策略：①临床诊断：严格执行1999年的诊断标准，根据临床资料综合分析，在排除其他心肌疾病的基础上做出诊断；②疑似诊断：补充心脏核磁检查和抗心肌抗体的检测作为筛查手段之一，弥补根据病史、临床表现和实验室检查诊断的不足，避免对一些非典型VMC患者的漏诊或误诊；③病原学诊断：在当前不能普及进行心肌活检的情况下，慎用心肌活检，同时重视对心肌肌钙蛋白的分析。

Diagnostic strategies for viral myocarditis

Clinical manifestations, symptoms and laboratory test results of early stage viral myocarditis （VMC） are lack of specificity; thus, accurate diagnoses are often difficult. The unified international standards for the diagnosis of VMC are not yet available. Overcautious diagnoses of VMC are hard to avoid and therapeutic delay caused by missed diagnoses is common. Using a literature review and summary of clinical research, we propose the following diagnostic strategies. Clinical diagnosis： diagnostic criteria of 1999 should be strictly followed and diagnoses should be made based on a comprehensive analysis of clinical data and exclusion of other myocardial diseases. Suspected diagnosis： screening examinations of magnetic resonance imaging （MRI） and anti myocardial antibody tests should be performed as supplements to the findings from the medical history, clinical manifestations and laboratory examinations so as to avoid missed or wrong diagnoses of atypical VMC. Etiological diagnosis： myocardial biopsy should be performed with caution and analysis of cardiac troponin could be conducted.