Costello John M, Alexander Mark E, Greco Karla M, Perez-Atayde Antonio R, Laussen Peter C
Harvard Medical School, Division of Cardiac Intensive Care, Department of Cardiology, Children's Hospital Boston, 300 Longwood Ave, Bader 600, Boston, MA 02115, USA.
Pediatrics. 2009 May;123(5):e835-41. doi: 10.1542/peds.2008-3058.
We sought to identify predictive factors for Lyme carditis in children and to characterize the clinical course of these patients.
We reviewed all cases of early disseminated Lyme disease presenting to our institution from January 1994 through July 2008, and summarized the presentation and course of those patients with carditis. A case-control study was used to identify predictive factors for carditis. Controls were patients with early disseminated Lyme disease without carditis.
Of 207 children with early disseminated Lyme disease, 33 (16%) had carditis, 14 (42%) of whom had advanced heart block, including 9 (27%) with complete heart block. The median time to recovery of sinus rhythm in these 14 patients was 3 days (range: 1-7 days), and none required a permanent pacemaker. Four (12%) of 33 patients with carditis had depressed ventricular systolic function, 3 (9%) of whom required mechanical ventilation, temporary pacing, and inotropic support. Complete resolution of rhythm disturbances and myocardial dysfunction occurred in 24 (89%) of 27 patients for whom follow-up data were available. Most patients with carditis also had other systemic Lyme involvement. By using multivariate logistic regression analysis, we found that children >10 years of age, those with arthralgias, and those with cardiopulmonary symptoms were more likely to have carditis.
The spectrum of presentation for children with Lyme carditis is broad, ranging from asymptomatic, first-degree heart block to fulminant myocarditis. Variable degrees of heart block are the most common manifestation and occasionally require temporary pacing. Transient myocardial dysfunction, although less common, can be life-threatening. Advanced heart block resolves within 1 week in most cases. In children with early disseminated Lyme disease, older age, arthralgias, and cardiopulmonary symptoms independently predict the presence of carditis.
我们试图确定儿童莱姆心肌炎的预测因素，并描述这些患者的临床病程。
我们回顾了1994年1月至2008年7月在我们机构就诊的所有早期播散性莱姆病病例，并总结了患有心肌炎的患者的临床表现和病程。采用病例对照研究来确定心肌炎的预测因素。对照为无心肌炎的早期播散性莱姆病患者。
在207例早期播散性莱姆病患儿中，33例（16%）患有心肌炎，其中14例（42%）出现高度房室传导阻滞，包括9例（27%）完全性房室传导阻滞。这14例患者恢复窦性心律的中位时间为3天（范围：1 - 7天），且无一例需要永久性起搏器。33例心肌炎患者中有4例（12%）出现心室收缩功能减退，其中3例（9%）需要机械通气支持、临时起搏和使用正性肌力药物。在有随访数据的27例患者中，24例（89%）的心律失常和心肌功能障碍完全缓解。大多数心肌炎患者还伴有其他系统性莱姆病累及表现。通过多因素逻辑回归分析，我们发现年龄大于10岁、有关节痛以及有心肺症状的儿童更易患心肌炎。
儿童莱姆心肌炎的临床表现范围广泛，从无症状的一度房室传导阻滞到暴发性心肌炎。不同程度的房室传导阻滞是最常见的表现，偶尔需要临时起搏。短暂的心肌功能障碍虽然较少见，但可能危及生命。大多数情况下，高度房室传导阻滞在1周内可缓解。在早期播散性莱姆病患儿中，年龄较大、有关节痛和心肺症状可独立预测心肌炎的存在。
