1998年台湾致命肠病毒感染的心脏表现。

S L Jan, C S Chi, B Hwang, Y C Fu, P Y Chen, S C Mak
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引用次数: 0

摘要

背景:1998年台湾爆发由肠道病毒感染引起的手足口病,造成70多名婴幼儿暴发性死亡。我们比较了肠病毒感染死亡病例和存活患者的心脏表现。方法:1998年4 ~ 6月在台中退伍军人总医院对187例肠病毒感染患者进行治疗。通过病史、临床特征、聚合酶链反应研究和/或病毒培养诊断肠病毒感染。对有无中枢神经系统(CNS)受累的7例(I组)、有中枢神经系统受累的30例(II组)和无中枢神经系统受累的150例(III组)进行心脏检查,包括全面体格检查、心电图和超声心动图检查。结果:三组患者在性别分布、发热天数、心率、全身血压、发病至入院时间等方面均无显著差异。除1例患者出现右侧心力衰竭和神经系统体征外,所有I组患者均有急性充血性心力衰竭、肺水肿和神经系统体征。超声心动图显示,ⅰ组缩短分数较低,射血分数较低,二尖瓣反流发生率较ⅱ组和ⅲ组更严重、更高(p < 0.01),但三组在收缩末期壁应力、左室舒张末期内径和心包积液发生率方面差异无统计学意义。结论:我们得出结论,7名婴儿和儿童(I组)死于严重心肌病或脑病。对肠病毒感染导致死亡的可能发病机制进行了综述和分析。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cardiac manifestations of fatal enterovirus infection during the 1998 outbreak in Taiwan.

Background: An outbreak of hand-foot-and-mouth disease caused by enterovirus infection occurred in Taiwan in 1998 and more than 70 infants and children with fulminant courses died. We compared the cardiac manifestations of fatal cases with patients who survived the enterovirus infection.

Methods: A total 187 patients with enterovirus infection were treated at Taichung Veterans General Hospital between April and June 1998. Enterovirus infection was diagnosed by history, clinical features, polymerase chain reaction study and/or viral culture. Cardiac examinations including complete physical examinations, electrocardiography and echocardiography were performed on seven cases (group I) with or without central nervous system (CNS) involvement, 30 patients with CNS involvement (group II), and 150 patients without CNS involvement (group III).

Results: There were no significant differences in sex distribution, days of fever, heart rate, systemic blood pressure or time from the onset of symptoms to hospital admission among the three groups. All group I patients had features of acute congestive heart failure, pulmonary edema and neurologic signs except one who presented with right-sided heart failure and neurologic signs. The echocardiographic findings of group I were a lower fractional shortening, lower ejection fraction, and more severe and higher incidence of mitral regurgitation (p < 0.01) than in groups II and III, but there were no significant differences in end-systolic wall stress, left ventricular end-diastolic internal dimension and incidence of pericardial effusion among the three groups.

Conclusions: We conclude that seven infants and children (group I) died due to either severe cardiomyopathy or encephalopathy. The possible pathogenesis of enterovirus infection leading to death is reviewed and analyzed.

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