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目的探讨登革热合并病毒性心肌炎的临床特点,提高对该病的诊治水平。方法对广州市第八人民医院2014年收治的138例登革热合并病毒性心肌炎患者的临床和辅助检查资料进行分析。结果 138例患者中男79例,女59例,平均年龄(60.01±21.54)岁,有基础病者87例,包括高血压34例(39.1%)、糖尿病14例(16.1%)、脂肪肝17例(19.5%)、脑梗塞9例(10.3%)和慢性病毒性肝炎13例(14.9%)。出现心肌炎临床症状者53例(38.4%),心肌酶谱异常者87例(63.0%),心电图异常者111例(80.4%),心脏彩超异常者53例(38.4%)。138例患者中,并发心功能不全者9例(6.5%),并发心源性休克2例(1.4%)。129例(93.5%)患者好转或治愈出院,9例未愈或死亡(6.5%),其中1例死于严重心律失常,1例死于心力衰竭。结论急性病毒性心肌炎是登革热的常见并发症之一,多发生于有基础病的老年人。临床表现多数为轻度心肌损伤,少数病例可发生严重心律失常或心力衰竭而死亡。
Objective To investigate the clinical features of dengue fever with viral myocarditis and to improve the diagnosis and treatment of the disease. Methods The data of 138 cases of dengue fever complicated with viral myocarditis admitted to Eighth People ’s Hospital of Guangzhou in 2014 were analyzed. Results There were 79 males and 59 females with a mean age of (60.01 ± 21.54) years. There were 87 patients with underlying diseases including 34 cases of hypertension (39.1%), 14 cases of diabetes mellitus (16.1%), 17 cases of fatty liver Cases (19.5%), cerebral infarction in 9 cases (10.3%) and chronic viral hepatitis in 13 cases (14.9%). Fifty-three patients (38.4%) had clinical symptoms of myocarditis, 87 (63.0%) had abnormal myocardial enzymes, 111 (80.4%) had abnormal electrocardiogram, and 53 (38.4%) had abnormal color Doppler ultrasound. Of the 138 patients, 9 (6.5%) had concurrent cardiac insufficiency and 2 had cardiogenic shock (1.4%). 129 patients (93.5%) were cured or discharged, and 9 were unhealed or died (6.5%). One died of severe arrhythmia and one died of heart failure. Conclusion Acute viral myocarditis is one of the common complications of dengue fever, which occurs in the elderly with underlying diseases. Most of the clinical manifestations of mild myocardial injury, a few cases of serious arrhythmia or heart failure and death.