Fulminant Giant Cell Myocarditis vs. Lymphocytic Myocarditis: A Comparison of Their Clinical Characteristics, Treatments, and Outcomes.
Fulminant Giant Cell Myocarditis vs. Lymphocytic Myocarditis: A Comparison of Their Clinical Characteristics, Treatments, and Outcomes.
复制标题
DOI：
10.3389/fcvm.2021.770549
复制
发表时间：
2021
影响因子：
3.6
通讯作者：
Tan H
中科院分区：
文献类型：
--
作者：
Hu Y;Ren J;Dong X;Zhang D;Qu Y;Yang C;Sun Y;Li J;Luo F;Wang W;Wang H;Qing P;Zhao S;Huang J;Yu L;Liu Y;Tan H
目的：暴发性心肌炎(Fm)是一种进展迅速且经常致死的心肌炎，一直难以分类。本研究旨在比较暴发性巨细胞性心肌炎(FGCM)和暴发性淋巴细胞性心肌炎(FLM)的临床特点、治疗方法和预后。方法和结果：11年来经组织学证实的FGCM患者9例(平均年龄47.9±7.5岁，女性6例)和FLM患者7例(平均年龄42.1±12.3岁，女性4例)。FGCM和FLM患者大多为NYHA功能IV级(56vs.100%，p=0.132)。高敏C反应蛋白[hs-CRP4.4(2.0-10.2)mg/L vs.13.6(12.6-14.6)mg/L，P=0.004]，肌酸激酶-肌红蛋白[CK-MB 1.4(1.0-3.2)ng/mlvs.14.6(3.0-64.9)ng/ml，P=0.025，IQR中位数]，丙氨酸转氨酶[ALT，38.0(25.0-61.5)Iu/L与997.0(50-3,080.0)Iu/L，P=0.030；右室舒张末内径[(2.9±0.3)cm比(2.4±0.6)cm，P=0.034，Mean±SD]。两组在主动脉内球囊反搏(44比43%，p=1.000)和体外膜肺氧合(11比43%，p=0.262)的使用上没有差异。FGCM组远期生存率为0.022%，显著低于FLM组的71.4%(P=0.05)。多因素COX回归分析显示，高敏C反应蛋白水平(危险比=0.871，95%可信区间：0.761~0.996，P=0.043)是FM患者的独立预后因素。此外，hs-CRP值对FGCM和FLM有较好的鉴别能力(AUC=0.9495%可信区间：0.4213~0.9964)。结论：FGCM患者的炎症反应和心肌损害较FLM患者轻。FGCM患者的预后明显比FLM患者差。Hs-CRP11.71 mg/L是鉴别FGCM和FLM的一个合适的临界点。
Objectives: Fulminant myocarditis (FM) is a rapidly progressive and frequently fatal form of myocarditis that has been difficult to classify. This study aims to compare the clinical characteristics, treatments and outcomes in patients with fulminant giant cell myocarditis (FGCM) and fulminant lymphocytic myocarditis (FLM). Methods and Results: In our retrospective study, nine patients with FGCM (mean age 47.9 ± 7.5 years, six female) and 7 FLM (mean age 42.1 ± 12.3 years, four female) patients confirmed by histology in the last 11 years were included. Most patients with FGCM and FLM were NYHA functional class IV (56 vs. 100%, p = 0.132). Patients with FGCM had significantly lower levels of high-sensitivity C-reactive protein [hs-CRP, 4.4 (2.0–10.2) mg/L vs. 13.6 (12.6–14.6) mg/L, P = 0.004, data shown as the median with IQR], creatine kinase-myoglobin [CK-MB, 1.4 (1.0–3.2) ng/ml vs. 14.6 (3.0–64.9) ng/ml, P = 0.025, median with IQR], and alanine aminotransferase [ALT, 38.0 (25.0–61.5) IU/L vs. 997.0 (50.0–3,080.0) IU/L, P = 0.030, median with IQR] and greater right ventricular end-diastolic diameter (RVEDD) [2.9 ± 0.3 cm vs. 2.4 ± 0.6 cm, P = 0.034, mean ± SD] than those with FLM. No differences were observed in the use of intra-aortic balloon pump (44 vs. 43%, p = 1.000) and extracorporeal membrane oxygenation (11 vs. 43%, p = 0.262) between the two groups. The long-term survival rate was significantly lower in FGCM group compared with FLM group (0 vs. 71.4%, p = 0.022). A multivariate cox regression analysis showed the level of hs-CRP (hazard ratio = 0.871, 95% confidence interval: 0.761–0.996, P = 0.043) was an independent prognostic factor for FM patients. Furthermore, the level of hs-CRP had a good ability to discriminate between patients with FGCM and FLM (AUC = 0.94, 95% confidence interval: 0.4213–0.9964). Conclusions: The inflammatory response and myocardial damage in the patients with FGCM were milder than those with FLM. Patients with FGCM had distinctly poorer prognoses compared with those with FLM. Our results suggest that hs-CRP could be a promising prognostic biomarker and a hs-CRP level of 11.71 mg/L is an appropriate cutoff point for the differentiating diagnosis between patients with FGCM and FLM.
登录
查看更多内容
影响因子：
8.8
作者：
Diddle, J. Wesley;Almodovar, Melvin C.;Thiagarajan, Ravi R.
通讯作者：
Thiagarajan, Ravi R.
影响因子：
158.5
作者：
Cooper, LT;Berry, GJ;Shabetai, R
通讯作者：
Shabetai, R
影响因子：
--
作者：
Maisch, Bernhard;Ruppert, Volker;Pankuweit, Sabine
通讯作者：
Pankuweit, Sabine
影响因子：
37.8
作者：
Ammirati, Enrico;Cipriani, Manlio;Frigerio, Maria
通讯作者：
Frigerio, Maria
影响因子：
2.7
作者：
Kilgallen, CM;Jackson, E;Surks, HK
通讯作者：
Surks, HK