Molina Kimberly M, Garcia Xiomara, Denfield Susan W, Fan Yuxin, Morrow William R, Towbin Jeffrey A, Frazier Elizabeth A, Nelson David P
Section of Pediatric Cardiology, Primary Children's Medical Center, University of Utah, 100 N Mario Capecchi Drive, Suite 1500, Salt Lake City, UT 84113, USA.
Pediatr Cardiol. 2013 Feb;34(2):390-7. doi: 10.1007/s00246-012-0468-4. Epub 2012 Aug 8.
Although parvovirus B19 (PVB19) currently is the most common cause of viral myocarditis, limited pediatric data exist. Whereas other viruses infect cardiomyocytes, PVB19 targets coronary endothelium, leading to myocardial ischemia and dysfunction. A retrospective review investigated patients with polymerase chain reaction (PCR)-verified PVB19 myocarditis at Texas Children's Hospital and Arkansas Children's Hospital (January 2005 to August 2008). The primary end points of the study were transplant-free survival and circulatory collapse (death, mechanical support, or transplantation). For the 19 patients identified (age, 6 months to 15 years), the most common presenting symptoms were respiratory and gastrointestinal. At admission, all the patients demonstrated ventricular dysfunction requiring inotropic support (median ejection fraction, 24 %; median left ventricle end-diastolic diameter [LVEDD] z-score, 4.6). Whereas T-wave abnormalities were common, ST elevation was evident in five patients (two died and three required transplantation). Serum B-type natrietic peptide was elevated in all 12 patients tested (range, 348-8,058 pg/ml), and troponin I was high in 7 of 9 patients (range, 0.04-14.5 ng/ml). Of the 15 patients with circulatory collapse, nine received mechanical support, eight underwent successful transplantation, and five died. Only six patients (32 %) experienced transplant-free survival, and five patients had full recovery of function at discharge. In the transplant-free survival group, ST changes on presenting electrocardiography were less likely (p = 0.03), and the admission LVEDD z-score tended to be lower (3.3 vs 5.6; p = 0.08). In children, PVB19 myocarditis causes significant mortality and morbidity. Although mechanical intervention can support patients in the initial stage of decompensated heart failure, patients with PVB19 myocarditis often demonstrate persistent dysfunction requiring medical therapy and transplantation.
尽管细小病毒B19（PVB19）目前是病毒性心肌炎最常见的病因，但儿科相关数据有限。其他病毒感染心肌细胞，而PVB19靶向冠状动脉内皮，导致心肌缺血和功能障碍。一项回顾性研究调查了得克萨斯儿童医院和阿肯色州儿童医院（2005年1月至2008年8月）经聚合酶链反应（PCR）证实为PVB19心肌炎的患者。该研究的主要终点是无移植生存和循环衰竭（死亡、机械支持或移植）。在确诊的19例患者（年龄6个月至15岁）中，最常见的首发症状是呼吸道和胃肠道症状。入院时，所有患者均表现出心室功能障碍，需要使用正性肌力药物支持（中位射血分数为24%；左心室舒张末期内径[LVEDD]z评分中位数为4.6）。虽然T波异常很常见，但5例患者出现ST段抬高（2例死亡，3例需要移植）。在接受检测的12例患者中，血清B型利钠肽均升高（范围为348 - 8058 pg/ml），9例患者中有7例肌钙蛋白I升高（范围为0.04 - 14.5 ng/ml）。在15例出现循环衰竭的患者中，9例接受了机械支持，8例成功接受了移植，5例死亡。只有6例患者（32%）实现了无移植生存，5例患者出院时功能完全恢复。在无移植生存组中，首次心电图检查时ST段改变的可能性较小（p = 0.03），入院时LVEDD z评分往往较低（3.3对5.6；p = 0.08）。在儿童中，PVB19心肌炎会导致显著的死亡率和发病率。虽然机械干预可以在失代偿性心力衰竭的初始阶段支持患者，但PVB19心肌炎患者常表现出持续的功能障碍，需要药物治疗和移植。
