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黄芪治疗病毒性心肌炎40例疗效观察

摘要:目的:观察黄芪注射液治疗病毒性心肌炎(VMC)的临床疗效。方法:选择心肌炎患者40例,随机为两组:对照组(20例)常规给予能量合剂、维生素C、聚肌胞及抗心律失常药物等对症治疗。治疗组(20例)在常规治疗的基础上加用黄芪注射液各40 ml,加入10葡萄糖液250ml滴注15 d治疗。 结果:治疗组与对照组相比.总有效率分别为95%和75%,两组相差显著(Plt;0.01),且未见不良反应。 结论:常规治疗基础上加用黄芪治疗病毒性心肌炎可缩短VMC病程,促进痊愈。

体外膜肺氧合抢救一例急性暴发型心肌炎

临床资料 男性患儿, 11 岁, 因“发热4 d, 腹痛1 d”入院。患儿4 d 前无明显诱因发热伴咽痛, 最高体温39 ℃, 就诊当地医院, 考虑“上呼吸道感染”, 输注头孢呋辛及对症处理, 效果欠佳, 转诊我院急诊。查体: 心率102 次/min, 呼吸34 次/min, 血压60 /32 mm Hg( 1 mmHg = 0. 133 kPa) , 体温38 ℃。K+ 5.4 mmoL/L, Na+ 126 mmoL/L, Cl - 95 mmoL/L,WBC 11. 5 ×109 /L, RBC 4. 76 ×1012 /L, Hb 120 g/L。心肌酶谱: CK 2098 U/L, CKMB 82 U/L, TNT 32. 1 U/L。ECG 提示:不规则多源性室性心律, Ⅲ度房室传导阻滞, 广泛导联ST-T损伤型改变。临床诊断: ①急性暴发型心肌炎; ②心源性休克; ③Ⅲ度房室传导阻滞。

Diagnostic Value of Cardiac MRI for Viral Myocarditis: A Systematic Review

Objective 　To evaluate the clinical value of cardiac MRI for the diagnosis of viral myocarditis (VMC). Methods　Such databases as PubMed (1950 to 2009), EMbase (1974 to 2009), and The Cochrane Library (December 2009) were searched to include clinical research reports of diagnosing viral myocarditis with MRI. QUADAS items were used to evaluate the quality of the included studies. The Meta-disc software was used to conduct merger analyses on sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. The Heterogeneity test was performed and summary receiver operating characteristic curve (SROC) was completed. Results　Five trials were included. The value of merger sensitivity, specificity, and diagnostic odds ratio (DOR) were 0.94, 0.69, 2.76, and 28.11, respectively. The area under of SROC curve (AUC) was 0.871 9. Conclusion　The current evidence shows that cardiac MRI has high sensitivity (94%) and moderate specificity (69%) in the diagnosis of viral myocarditis. The positive rate in the viral myocarditis group is 28.11 times as high as that in the non-viral myocarditis group, so Cardiac MRI has good diagnostic values for viral myocarditis.

Shenmai Injection for Children with Viral Myocarditis: A Systematic Review

Objective　To assess the efficacy and safety of Shenmai injection for children with viral myocarditis. Methods　All randomized and quasi-randomized controlled trials (RCTs and quasi-RCTs) of Shenmai injection for children with viral myocarditis were searched from CBM (1981 to November 2009), CNKI (1980 to November 2009) and VIP (1989 to November 2009), The Cochrane Library (Issue 1,2010), PubMed (1966 to 2009), EMbase (1966 to 2009). Cochrane systematic reviews Handbook 5.0.1 was taken as a reference to quality evaluation of the included studies, and the Cochrane Collaboration’s RevMan 5.0 software was used for data analyses. Results　A total of 15 RCTs were included. The quality of the included trials was low. The result of meta-analyses showed that: (1) The effective rate (RR 1.16, 95%CI 1.07 to 1.25) and the ECG improvement rate (RR 1.55, 95%CI 1.25 to 1.93) in Shenmai injection group were better than those in the control group. CK and CK-MB in Shenmai injection were lower than those in the control group, but the AST level was similar in the two groups. (2) The effective rate (RR 1.12, 95%CI 1.01 to 1.25) and the ECG improvement rate (RR 1.35, 95%CI 1.07 to 1.70) in Shenmai injection group were better than those in the western medicine plus routine therapy (RT) group. CK, AST and LDH in Shenmai injection group were lower than those in the western medicine plus RT group, but CK-MB was similar in the two groups. (3) The effective rate (RR 1.26, 95%CI 1.12 to 1.42) in Shenmai injection plus RT and western medicine group was better than that in RT and western medicine group. CK and LDH-1 in Shenmai injection plus RT and western medicine group were lower than those in RT and western medicine group. Adverse reactions of Shenmai injection in 4 studies included mild rash, rubicundity and chest distress. No severe adverse reactions were reported. Conclusion　The evidence currently available shows that Shenmai injection may have some effect on children with viral myocarditis, including improving the effective rate, reducing myocardial enzymes and improving the ECG improvement rate. However, because of the low methodological quality of the included trials, this conclusion needs to be interpreted cautionsly, and more well-designed, high-quality RCTs need to be performed.

心脏磁共振诊断酷似心肌梗死的急性心肌炎二例

误诊为急性心肌炎的心肌梗死一例

体外膜肺氧合联合连续性肾脏替代治疗救治急性重症心肌炎合并心肾综合征一例

Efficacy and safety of dexamethasone in the treatment of viral myocarditis: a meta-analysis

ObjectiveTo systematically review the efficacy and safety of dexamethasone in the treatment of viral myocarditis.MethodsThe Cochrane Library, PubMed, EMbase, Biosis Preview, Web of Science, CBM, WanFang Data, VIP, and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) on dexamethasone for patients with viral myocarditis from inception to April 30th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software.ResultsA total of 7 RCTs involving 749 patients were included. The results of meta-analysis showed that the dexamethasone treatment group exhibited an increased efficacy rate (RR=1.26, 95%CI 1.18 to 1.34, P<0.000 01), decreased levels of C-reactive protein (CRP) (MD=−11.49, 95%CI −19.25 to −3.72, P=0.004), cardiac troponin I (cTnI) (MD=−26.14, 95%CI −40.82 to −11.47, P=0.0005), and creatine kinase MB (CK-MB) (MD=−20.06, 95%CI −28.35 to −11.77, P<0.000 01), and a decreased adverse event rate (RR=0.40, 95%CI 0.24 to 0.65, P=0.000 3).ConclusionsCurrent evidence shows that dexamethasone can significantly improve the efficacy rate, reduce the levels of CRP, cTnI, and CK-MB, and reduce the incidence of adverse events in patients with viral myocarditis. Due to the limited quantity and quality of included studies, more high-quality studies are required to verify above conclusions.

Risk analysis of myocarditis induced by immune checkpoint inhibitors: a real-world study based on the open FDA database

ObjectiveTo investigate the risk of myocarditis caused by immune checkpoint inhibitors (ICI). MethodsThe adverse reaction (ADR) reports on myocarditis caused by atelizumab, duvalizumab, pabolizumab, and navulizumab were downloaded from the FDA Adverse Event Reporting System (FAERS) from January 1, 2014 to September 30, 2022. The relevant analysis was conducted on the gender, age, medication dosage, and occurrence time of ICI related myocarditis patients. ResultsA total of 1 892 reports of myocarditis induced by ICI were included. The proportion of myocarditis caused by ICI was higher in males than in females (1.9∶1). The incidence of myocarditis in patients with basic diseases such as diabetes and heart disease, and in the age group 65-75 was relatively high. The incidence of myocarditis caused by navulizumab was high within 30 days with the use of conventional doses, and that of the other three drugs were high within 31 to 90 days. And the incidence of myocarditis is higher when used in combination than when used alone. ConclusionDifferent varieties of ICI can lead to the occurrence of myocarditis, and male, elderly, underlying diseases, and combination therapy may be risk factors for myocarditis caused by ICI.