老年暴发性心肌炎的临床特征
Clinical characteristics of old patients with fulminant myocarditis

周宁.老年暴发性心肌炎的临床特征[J].内科急危重症杂志,2017,23(6):456-458

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DOI：10.11768/nkjwzzzz20170604

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基金项目:国家重点基础研究计划（973计划）（No:2014CB541601，No:2012CB518004);国家自然科学基金(No:81570261，No:81100087)

作者	单位	E-mail
周宁	华中科技大学同济医学院附属同济医院	dwwang@tjh.tjmu.edu.cn

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中文摘要:

摘要目的：研究老年暴发性心肌炎（FM）的临床特征，为其诊断和治疗提供依据。方法：回顾性分析87例临床诊断为FM并接受规范药物治疗和机械辅助治疗的患者。按照年龄进行分组：≥60岁，40~59岁，20~39岁，10~19岁。比较≥60岁的老年患者与其他年龄组FM患者的临床特征。结果: 老年FM占临床FM患者比例为10.3%，其中男性患者居多。老年FM起病更为隐匿，从前驱期症状到出现明显心功能不全的潜伏期长，发热较少，肾功能不全比例高，病死率更高。老年FM患者心功能更差，心肌损伤更为严重，易出现各种类型心律失常，需要心脏临时起搏治疗的比例更高、时间更长。结论: 老年FM临床并不少见，其起病隐匿、潜伏期长，且其他脏器损伤多见，临床表现不典型，预后更差。

英文摘要:

Objective: To explore the clinical characteristics of the old patients with fulminant myocarditis (FM). Methods: The clinical data of 87 FM patients who treated with standardized medical therapy and mechanical circulatory support therapy were retrospectively analyzed. According to the age, the subjects were divided into 4 groups: older than 60 years; 40-59 years; 20-39 years; 10-19 years. Results: Elderly (≥60) patients with FM accounted for 10.3% of the total patients with a majority of male. The old FM patients were more secretive. The incubation period of old FM patients was very long from the initial infectious symptom to the cardiac dysfunction with an untypical clinical manifestation (for example, less fever). FM in old patients was worse and caused higher mortality than the younger patients. Elderly patients with FM had worse cardiac function, more severe myocardial injury, prone to various types of arrhythmia. The need for temporary cardiac pacing treatment ratio in old FM patients was higher and the duration was longer than younger patients. Conclusion: Elderly patients with FM is not uncommon as traditionally thought before. It onsets occultly, and has longer incubation period and atypical clinical manifestations with heavier heart damage and higher mortality.