Study Of The Clinical Significance Of HCMV In Children With Viral Myocarditis

Objective: To explore the clinical significance of hunYan cytomegalovirus (HCMV) in patients with viral myocarditis, analyze the correlation between the severiety of myocardial injury and the amount of HCMV DNA, investigate clinical features of HCMV DNA (+) patients and to evaluate the effects of Ganciclovir on HCMV.Methods : Fluorescent Quantitative Polymerase Chain Reaction (FQ-PCR) was performed in 65 patients with viral myocarditis and 35 healthy children. 65 patients were divided into 2 groups: Group I : HCMV-DNA(+), HCMV-IgM(+), IgM of Cox virus and other pathogens (-); Group II: HCMV-DNA(-), Cox-IgM(+), IgM of other pathogens (-); Relationships between HCMV gene copies and levels of serum CK-MB, CTnT were analysed. CK-MB levels, ECG, cardiac function(LVEF, LVFS, CI, E/A) and other respects between Group I and Group II were evaluated. Patients with positive HCMV-DNA were treated with ganciclovir(GCV 5mg/kg, iv, q!2h, for 2 or 3weeks, and then 5mg/kg, iv, tiw, for 4 weeks).Results: The positivity rate of HCMV-DNA of patients with myocarditis was obviously higher than that of the control group, and the difference had statistical significance( x 2=5.35, P<0.05). The HCMV-DNA copies were highly positively correlated with the serum CK-MB, CTnT, respectively(r=0.759, 0.822; P<0.01, 0.01). CK-MB levels of Group I were markedly higher than those of Group II (t=8.71, P<0.01). Heart systolic functions(LVFS, LVEF, CI) in Group I were significantly lower than those of Group II (t=5.89, 6.20, 3.05, PO.01, 0.01,0.05), but had no significance of heart diastolic function(t=1.22, P>0.05). Electrocardiogram showed that Group I had more conduction blocks (8/19) and 1 supraventricular tachycardia; While Group II showed more premature beats( 13/37).Group I had 2 patients with jundice, 4 patients had the elevated transaminomerase, and 1 congenital brain hydrops. After treated with Ganciclovir HCMV gene copies in blood decreased significantly(t=5.654, P<0.01) .Conclution : HCMV may be one of the important causes in children with viral myocarditis. FQ-PCR was an effective method in the diagnosis of myocardial injury by HCMV. Patients with positive HCMV-DNA had the elevated levels of CK-MB, the decreased systolic function and more conduction blocks, indicating a severer myocardial injury. Ganciclovir was effective against HCMV infection; Patients with positive HCMV-DNA should be treated formally with antiviral drugs and a long-term follow-up should be performed.Postgraduate: Zhou Haiyan (Pediatrics) Directed by: Professor Wang Wendi...