Parvovirus B19 Myocarditis Causes Significant Morbidity and Mortality in Children
Parvovirus B19 Myocarditis Causes Significant Morbidity and Mortality in Children
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DOI：
10.1007/s00246-012-0468-4
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发表时间：
2013-02-01
影响因子：
1.6
通讯作者：
Nelson, David P.
中科院分区：
文献类型：
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作者：
Molina, Kimberly M.;Garcia, Xiomara;Nelson, David P.
虽然细小病毒B19（PVB 19）目前是病毒性心肌炎最常见的原因，但儿科数据有限。尽管其他病毒感染心肌细胞，但PVB 19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德克萨斯州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）验证的PVB 19心肌炎患者。研究的主要终点是无移植存活率和循环衰竭（死亡、机械支持或移植）。对于确定的19名患者（年龄，6个月至15岁），最常见的表现症状是呼吸道和胃肠道。入院时，所有患者均表现出需要正性肌力支持的心室功能障碍（中位射血分数，24%;中位左心室舒张末期直径[LVEDD] z评分，4.6）。虽然T波异常是常见的，ST段抬高是明显的五名患者（2人死亡，3人需要移植）。所有12例受试患者的血清B型钠肽均升高（范围为348- 8，058 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例循环衰竭患者中，9例接受了机械支持，8例移植成功，5例死亡。只有6名患者（32%）经历了无移植存活，5名患者在出院时功能完全恢复。在无移植存活组中，心电图显示ST段改变的可能性较小（p = 0.03），入院时LVEDD z评分倾向于较低（3.3 vs 5.6; p = 0.08）。在儿童中，PVB 19心肌炎导致显著的死亡率和发病率。尽管机械干预可以在失代偿性心力衰竭的初始阶段支持患者，但患有PVB 19心肌炎的患者通常表现出持续的功能障碍，需要药物治疗和移植。
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.