Seattle Children's Hospital, Seattle, WA, USA.
Pediatr Cardiol. 2023 Feb;44(2):441-450. doi: 10.1007/s00246-022-03004-w. Epub 2022 Sep 12.
There is considerable variability in practice among pediatric centers for treatment of myocarditis. We report outcomes using high dose steroids in conjunction with IVIG. This is a single center retrospective study of children < 21 years of age diagnosed with myocarditis and treated with high dose steroids and IVIG from January 2004-April 2021. Diagnostic criteria for myocarditis included positive endomyocardial biopsy, cardiac magnetic resonance (CMR) imaging meeting Lake Louise criteria, or strictly defined clinical diagnosis. Forty patients met inclusion criteria. Median age at diagnosis was 11.6 years (0.7-14.6). Diagnosis was made clinically in 70% of cases (N = 28), by CMR in 12.5% (N = 5) and by biopsy in 17.5% (N = 7). Median ejection fraction (EF) at diagnosis was 35% (IQR 24-48). Median duration of IV steroids was 7 days (IQR 4-12) followed by an oral taper. Median cumulative dose of IV immunoglobulin (IVIG) was 2 g/kg. There were no serious secondary bacterial infections after steroid initiation. Ten patients (25%) required mechanical circulatory support. Overall transplant free survival was 92.5% with median follow-up of 1 year (IQR 0-6 years). Six patients required re-admission for cardiovascular reasons. By 3 months from diagnosis, 70% of patients regained normal left ventricular function. High dose steroids in conjunction with IVIG to treat acute myocarditis can be safe without significant infections or long-term side effects. Our cohort had excellent recovery of ventricular function and survival without transplant. Prospective comparison of a combination of high dose steroids with IVIG versus other therapies is needed.
儿科中心在心肌炎治疗方面的实践存在相当大的差异。我们报告了使用大剂量类固醇联合 IVIG 的治疗结果。这是一项单中心回顾性研究，纳入了 2004 年 1 月至 2021 年 4 月期间年龄小于 21 岁、诊断为心肌炎并接受大剂量类固醇和 IVIG 治疗的儿童。心肌炎的诊断标准包括心内膜心肌活检阳性、符合莱克·路易斯标准的心脏磁共振成像（CMR）或严格定义的临床诊断。40 名患者符合纳入标准。中位诊断年龄为 11.6 岁（0.7-14.6 岁）。70%（28 例）的病例为临床诊断，12.5%（5 例）为 CMR 诊断，17.5%（7 例）为活检诊断。诊断时的中位射血分数（EF）为 35%（24-48）。静脉类固醇的中位持续时间为 7 天（4-12 天），随后进行口服减量。静脉免疫球蛋白（IVIG）的中位累积剂量为 2g/kg。类固醇治疗开始后无严重继发细菌性感染。10 名患者（25%）需要机械循环支持。无移植存活率为 92.5%，中位随访时间为 1 年（0-6 年）。6 名患者因心血管原因再次入院。诊断后 3 个月，70%的患者左心室功能恢复正常。大剂量类固醇联合 IVIG 治疗急性心肌炎是安全的，没有明显的感染或长期副作用。我们的队列在没有移植的情况下心室功能和存活率恢复良好。需要前瞻性比较大剂量类固醇联合 IVIG 与其他治疗方法的效果。
