Abstract: Objective    To investigate the early clinical features and risk factors of fulminant myocarditis in children， and to provide clinical experience for the early identification of fulminant myocarditis. Methods    The clinical data of 51 children with fulminant myocarditis and 62 children with acute myocarditis admitted to the Children's Hospital of Chongqing Medical University from January 2015 to January 2022 were retrospectively analyzed. Results    （1） The age at the onset of the disease in the fulminant myocarditis group was older， with the incidence of Asian seizures， dizziness， headache， dyspnea， nausea， vomiting， abdominal pain， bloating， oliguria， altered consciousness， low heart sounds， irregular heartbeat， cold extremities， facial changes， and liver enlargement being greater than that in the acute myocarditis group （P<0.05）. （2） Compared with the acute myocarditis group， white blood cell count， C-reactive protein， hypertroponin I， creatine kinase isoenzyme MB type， lactate dehydrogenase， alanine aminotransferase， aspartate aminotransferase， blood creatinine， blood urea nitrogen， albumin， left heart function， cardial enlargement ventricular septum， wall mobility and thickness， pericardial effusion， moderate and severe regurgitation of the ditricuspid valve， ventricular tachycardia， escape beat， ventricular fibrillation/ventricular arrest， third-degree atrioventricular block， and bundle branch block in the fulminant myocarditis group had significant differences （P<0.05）， but there was no significant difference in the detection rate of various etiologies between the two groups （P>0.05）. （3） Logistic regression analysis showed that albumin， left ventricular ejection fraction， third-degree atrioventricular block， and bundle branch block were predictive risk factors for fulminant myocarditis；Logistic regression equation P=1/［1+e-（92.862-0.171×ALB-0.351×LVEF+6.286×Ⅲ°atrioventricular block+5.492×bundle branch block）］， sensitivity was 94.1% and specificity was 96.8%，with good discrimination. （4） Children with fulminant myocarditis were given comprehensive treatment such as immune regulation， anti-arrhythmia， anti-heart failure， and anti-infection， and 3 children （5.8%） died. Conclusion    The clinical manifestations of fulminant myocarditis in children are atypical， with low albumin in the early stage， decreased left ejection fraction， third-degree atrioventricular block and bundle branch block being predictive risk factors for fulminant myocarditis.

Key words: fulminant myocarditis, clinical features, risk factors, treatment

摘要： 目的    探讨儿童暴发性心肌炎早期临床特点及危险因素，为早期识别暴发性心肌炎提供临床经验。方法    回顾性对比分析2015年1月至2022年1月重庆医科大学附属儿童医院收治的51例暴发性心肌炎患儿及62例急性心肌炎患儿的临床资料。结果    （1）暴发性心肌炎组起病年龄较大，有阿斯综合征发作，头晕、头痛，呼吸困难，恶心、呕吐，腹痛、腹胀，少尿，意识改变，心音低钝，心律不齐，肢端凉，面色改变，肝脏肿大等起病时临床表现及体征的发生率均大于急性心肌炎组（P<0.05）；（2）暴发性心肌炎组中白细胞计数、C反应蛋白、超敏肌钙蛋白Ⅰ、肌酸激酶同工酶MB型，乳酸脱氢酶、丙氨酸转氨酶、天冬氨酸转移酶、血肌酐、血尿素氮、白蛋白、左心功能，心腔增大，室间隔、室壁动度及厚度，心包积液，二、三尖瓣中重度反流，室性心动过速，逸搏，室颤／室性停搏，Ⅲ度房室传导阻滞，束支传导阻滞等指标与急性心肌炎组相比，差异均有统计学意义（P<0.05）；但两组各类病原学检出率比较差异无统计学意义（P>0.05）；（3）Logistic回归分析显示白蛋白、左室射血分数、Ⅲ度房室传导阻滞、束支传导阻滞是发生暴发性心肌炎的预测危险因素；Logistic回归方程P=1/［1+ｅ-（92.862-0.171×白蛋白-0.351×左室射血分数+6.286×Ⅲ度房室传导阻滞+5.492×束支传导阻滞）］，敏感度为94.1％，特异度为96.8％，区分度良好；（4）暴发性心肌炎患儿经免疫调节、抗心律失常、抗心力衰竭、抗感染等综合治疗，死亡3例（5.8％）。结论    儿童暴发性心肌炎早期出现白蛋白降低、左室射血分数降低、Ⅲ度房室传导阻滞、束支传导阻滞是暴发性心肌炎的预测危险因素。

关键词: 暴发性心肌炎, 临床特点, 危险因素, 治疗