| ObjectiveBy comparing the levels of cytokines between the fulminant myocarditis group and the common viral myocarditis group,and analyzing the clinical characteristics,auxiliary examination,treatment of the two groups,to provide theoretical basis for early assessment and prognosis of fulminant myocarditis.MethodA total of 45 cases of fulminant myocarditis(FMC)were first diagnosed between January 2013 and December 2018 by the Children’s Hospital of Zhejiang University,and children with acute myocarditis(non-fullinant,NFC)who had improved cytokine detection at the same time were collected.Sixty-five patients were analyzed by SPSS 20.0 statistical software.The cytokines of FMC group(including IL-2、IL-4、IL-6、IL-10、IFN-y、TNF,before and after treatment)were compared with those of NFC group,at the same time,general condition,onset season,initial clinical symptoms,laboratory examination,imaging examination,electrocardiogram,treatment,prognosis were all compared.Result1.Cytokines:The mean values of IL-2,IL-6 and IL-10 in the acute phase of FMC group were 7.21±7.58pg/ml,134.63±400.89pg/ml and 37.75±65.59pg/ml,respectively,compared with the mean recovery period of 4.34±7.51 pg/Ml,13.58±19.43pg/ml,6.67±7.47pg/ml were significantly higher(P<0.05),and the average value of the NFC group was 4.94±7.50pg/ml,19.43±37.27pg/ml,7.08±9.62pg/ml.The levels were significantly higher(P<0.05),but the mean levels of IL-2,IL-6 and IL-10 in the recovery period were not significantly different from those in the NFC group(P>0.05).The FMC group was IL-4,TNF and IFN-y.There was no significant difference between the mean acute phase and recovery phase and the recovery phase and NFC group(P>0.05).2.Laboratory examination:The mean WBC and CRP of the FMC group were(10.69±5.01)×109/L and 18.14±28.53 mg/L,respectively,compared with the average of the NFC group(8.16±3.53)×109/L,6.02± The increase of 6.75mg/L(P<0.05);the mean values of myocardial injury markers CK-MB,TnT,BNP and AST in FMC group were 62.1 ±65ng/ml,1.5±2.3ng/ml and 13607.4± 11155pg/ml,respectively.The average value of 327.5±608.1 U/L compared with NFC group was 9.5±23.8 ng/ml,0.2±0.5 ng/ml,1646.8±5741 pg/ml,and 50.2±5.0 U/L(P<0.05);mean values of biochemical indicators ALT,Cre,Ure were 164.3±300.5 U/L,72.8±31.2 μmol/L,and 7.4±43 mmol/L,respectively,compared with the NFC group average of 9±23.8 U/L,53.8± 14.0 pmol/L,and 4.2±4.2 mmol/L are increased(P<0.05).3.Special examination:The changes of ECG in FMC group were most seen as heart rate change(60.4%),conduction block(53.5%),ST-T change(44.2%),heart-thorax ratio average of 0.57±0.039,88.1%LVEF fall off,The mean value was 0.49±0.111;the most significant changes in ECG in the NFC group were ST-T changes(40%),premature beats/escape(32.3%),sinus arrhythmia(29.2%),etc.,and the average cardiothoracic ratio was 0.52±0.062,LVEF were all>0.5,and the mean value was 0.65±0.063.The LVEF in the NFC group was significantly higher than that in the FMC group(P<0.05).4.Clinical manifestations:The most common symptoms of initial symptoms in the FMC group were digestive symptoms(57.8%),followed by cardiovascular symptoms(51.1%),neurological symptoms(24.4%);the most common symptoms in the NFC group were cardiovascular symptoms(75.4%),followed by respiratory symptoms(36.9%)and gastrointestinal symptoms(23.1%).5.Treatment and prognosis:FMC group was severe,mortality was high(22.2%),54.8%were treated with ECMO,and the average length of hospital stay was longer than that of NFC group(P<0.05).ConclusionsIn the early stage of FMC,the levels of serum IL-2,IL-6 and IL-10 were significantly higher in the FMC group than in the NFC group,and the age of FMC was elder than that of NFC.It is believed that the rapid and strong secondary immune response in the development of FMC disease plays an important role.FMC rapidly showed diffuse myocardial contraction,decreased left ventricular ejection fraction,insufficient systemic blood supply,and multiple systemic injuries.The initial clinical symptoms were characterized by digestive system symptoms and nervous system symptoms,and the index of heart,liver and kidney function was increased,abnormal ECG,decreased LVEF,long hospital stay in FMC,high mortality,we should identify FMC early,correctly identify the timing of applying ECMO,to improve the prognosis of FMC. |
PDF Full Text Request