儿童病毒感染相关性临界心肌炎的诊治研究

目的　探讨有关儿童病毒性心肌炎(childhood viral myocarditis,VMC)的诊断问题,验证 1999 年昆明会议修订的新的儿童VMC诊断标准。方法　总结近3年来收治入院的 50 例具有明显病毒感染相关的以心脏损害的患儿的临床表现、特殊检查和治疗转归,按该儿童VMC诊断标准计算诊断符合率,提出儿童VMC诊断标准需要不断完善的主要依据。结果　根据病史、体征、辅助检查结果、鉴别诊断、治疗疗效和临床转归,本组50例患儿均存在病毒感染相关的心肌炎表现特征,但完全符合该诊断标准仅有 14 例,符合率为 28%。结论　儿童 VMC诊断标准仍需不断修改与完善。在此之前,对存在明显病毒感染依据的可疑病例,采用“临界心肌炎”的诊断,既能够保证患儿得到及时与合适的治疗,也为今后的诊断标准修订提供必要的参考依据。

Study on Diagnosis and Treatment of Childhood Viral Myocarditis

Objective To study the diagnosis of childhood viral myocarditis (VMC) and to validate the Diagnosis Standard of VMC in Children set by Kunming Conference in 1999.Methods Bringing forward the major arguments about continuously improving Diagnosis Standard of VMC in Children,50 viral myocarditis treated in our hospital in recent three years were reviewed.Their clinical manifestation and outcomes according to the Diagnosis Standard of VMC in Children were studied.Results All 50 cases of this study group had obvious clinical manifestations of virus-associated pathological changes of heart,but only fourteen of these patients (28%) completely accorded with the Diagnosis Standard of VMC in Children set by Kunming Conference in 1999.Conclusion It is necessary for the Diagnosis Standard of VMC in children to be improved continuously.And before that,the term of virus-associated critical myocarditis should be adopted to those unconfirmed cases.Clinical use of the virus-associated critical myocarditis standard not only can ensure the patients to get suitable treatment in time,but also provide necessary reference for amending the diagnosis standard of VMC of children in the future.