Mokuno T, Sawai Y, Oda N, Mano T, Hayakawa N, Kato R, Itoh Y, Shimazaki K, Kotake M, Nakai A, Hiramitsu S, Itoh M, Morimoto S, Nagasaka A
Department of Internal Medicine, Fujita Health University School of Medicine, Aichi, Japan.
Diabetes Care. 1996 Apr;19(4):374-8. doi: 10.2337/diacare.19.4.374.
We report a case of diabetic ketoacidosis (DKA) complicated by acute myocarditis, which was confirmed by cardiac biopsy. A 26-year-old man was hospitalized with severe DKA. On admission, nonspecific ST-T change was noted on the electrocardiogram (ECG). The patient's levels of creatine phosphokinase (CPK) and glutamic oxaloacetic transaminase were slightly elevated, but he did not complain of chest discomfort or symptoms of heart disease. On the first day after admission, ST-T elevation was noted on ECG during treatment of DKA. By cardiac angiography and cardiac biopsy, coronary heart disease was ruled out and postmyocarditic change was histologically confirmed. An episode of upper respiratory viral infection before the onset of acute diabetes suggested that the patient suffered from viral-induced myocarditis and consequent development of IDDM. This possibility was confirmed by the clinical course of ECG change, with elevated CPK and lactate dehydrogenase and a slightly elevated antibody titer for echovirus.
我们报告一例糖尿病酮症酸中毒（DKA）并发急性心肌炎的病例，该病例经心脏活检确诊。一名26岁男性因严重DKA入院。入院时，心电图（ECG）显示非特异性ST-T改变。患者的肌酸磷酸激酶（CPK）和谷草转氨酶水平略有升高，但他未诉说胸部不适或心脏病症状。入院后第一天，在DKA治疗期间心电图显示ST-T抬高。通过心脏血管造影和心脏活检，排除了冠心病，并经组织学证实为心肌炎后改变。急性糖尿病发作前的一次上呼吸道病毒感染提示患者患有病毒诱导的心肌炎以及随后发生的胰岛素依赖型糖尿病（IDDM）。心电图改变的临床过程、CPK和乳酸脱氢酶升高以及埃可病毒抗体滴度略有升高证实了这种可能性。
