Jie Y C, Jiang Y W, Liang K J, Zhou X O, Zhang C T, Fu Z, Zhao Y H
Cardiovascular Intensive Care Unit, Dongguan Kanghua Hospital, Dongguan 523000, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2022 Mar 24;50(3):277-281. doi: 10.3760/cma.j.cn112148-20210519-00432.
To investigate the relationship between the mechanical circulatory support (MCS) combined with immunomodulation and the prognosis of patients with fulminant myocarditis. This is a retrospective study. A total of 88 patients with fulminant myocarditis admitted to Dongguan Kanghua hospital from Aug. 2008 to Dec. 2020 were included. Medical histories, results of laboratory tests, treatment regimens and clinical outcomes of these patients during their hospitalization were collected from the medical record system. According to the treatment methods, the patients were divided into MCS+immunomodulation group (38 cases), MCS group (20 cases) and traditional treatment group (30 cases). Patients in the MCS+immunomodulation group received intra-aortic balloon pump (IABP) or IABP combined with extracorporeal membrane oxygenation (ECMO) and immunoglobulin or glucocorticoid. Patients in the MCS group only received mechanical circulatory support. Patients in the traditional treatment group received neither mechanical circulatory support nor immunomodulatory therapy, and only used vasoactive drugs and cardiotonic drugs. The in-hospital mortality and length of stay were compared among the three groups. A total of 88 patients with fulminant myocarditis aged (35.0±10.8) years were included, and there were 46 males (52.3%). The mortality of MCS+immunomodulation group (7.9% (3/38) vs. 56.7% (17/30), =0.001 2) and MCS group (30.0% (6/20) vs. 56.7% (17/30), =0.002 8) were lower than that of traditional treatment group. Compared with the MCS group, the in-hospital mortality in the MCS+immunomodulation group was lower (=0.005 4). The most common cause of death was multiple organ dysfunction syndrome (MODS). The constituent ratios of death in MCS+immunomodulation group, MCS group and traditional treatment group were 3/3, 4/6 and 12/17, respectively. The incidence of MODS in the MCS group (20% (4/20)) and the traditional treatment group (40% (12/30)) was significantly higher than that in the MCS+immunomodulation group (7.9% (3/38)) (both <0.01). In discharged patients, the hospitalization time of MCS+immunomodulation group was shorter than that of traditional treatment group ((13.4±5.5)d vs. (18.5±7.4)d, <0.05) and MCS group ((13.4±5.5)d vs. (16.9±8.5)d, <0.05). MCS combined with immunomodulatory therapy is associated with lower in-hospital mortality and shorter hospital stay in patients with fulminant myocarditis.
探讨机械循环支持（MCS）联合免疫调节与暴发性心肌炎患者预后的关系。这是一项回顾性研究。纳入2008年8月至2020年12月在东莞康华医院住院的88例暴发性心肌炎患者。从病历系统中收集这些患者的病史、实验室检查结果、治疗方案及住院期间的临床结局。根据治疗方法，将患者分为MCS+免疫调节组（38例）、MCS组（20例）和传统治疗组（30例）。MCS+免疫调节组患者接受主动脉内球囊反搏（IABP）或IABP联合体外膜肺氧合（ECMO）以及免疫球蛋白或糖皮质激素治疗。MCS组患者仅接受机械循环支持。传统治疗组患者既未接受机械循环支持也未接受免疫调节治疗，仅使用血管活性药物和强心药物。比较三组患者的院内死亡率和住院时间。共纳入88例年龄为（35.0±10.8）岁的暴发性心肌炎患者，其中男性46例（52.3%）。MCS+免疫调节组（7.9%（3/38）对56.7%（17/30），P=0.001 2）和MCS组（30.0%（6/20）对56.7%（17/30），P=0.002 8）的死亡率低于传统治疗组。与MCS组相比，MCS+免疫调节组的院内死亡率更低（P=0.005 4）。最常见的死亡原因是多器官功能障碍综合征（MODS）。MCS+免疫调节组、MCS组和传统治疗组的死亡构成比分别为3/3、4/6和12/17。MCS组（20%（4/20））和传统治疗组（40%（12/30））的MODS发生率显著高于MCS+免疫调节组（7.9%（3/38））（均P<0.01）。在出院患者中，MCS+免疫调节组的住院时间短于传统治疗组（（13.4±5.5）天对（18.5±7.4）天，P<0.05）和MCS组（（13.4±5.5）天对（16.9±8.5）天，P<0.05）。MCS联合免疫调节治疗可降低暴发性心肌炎患者的院内死亡率并缩短住院时间。
