【www.zhangdahai.com--科学科技公文】
［摘要］ 目的 分析酷似急性心肌梗死(AMI)的暴发性心肌炎(FM)的临床特点。方法 对8例心电图出现典型AMI样改变的FM患者，从病史特点、临床表现、辅助检查等方面进行分析。结果 8例患者既往均无冠心病、糖尿病等病史。6例在发病前有上呼吸道感染症状，5例心电图的前壁及下壁导联上同时有ST段抬高或异常Q波，8例患者心肌损伤标志物均明显升高。3例心脏超声检查示心脏结构无明显异常，但收缩功能减退；5例左心室腔明显扩大，心脏收缩功能明显减退。8例均未见心脏节段性功能障碍。2例行急诊冠脉造影术，结果均未发现冠状动脉有明显狭窄。6例应用了主动脉内气囊反搏术。抢救成功7例，死亡1例。结论 酷似AMI的FM发病急骤，病情凶险，分析其临床特点对于及早确诊、积极治疗和改善患者的预后具有重要意义。�
［关键词］ 暴发性心肌炎；急性心肌梗死；心电描记术�
［中图分类号］ R542.21［文献标识码］ A［文章编号］ 1671-7562(2008)04-0252-03
Clinical analysis of acute myocardial infarction-like fulminant myocarditis
CHEN Long，ZHANG Xiao-li，TANG Cheng-chun，FENG Yi，MA Gen-shan
(Department of Cardiology,Zhangda Hospital，Southeast University，Nanjing 210009,China)
Abstract: Objective To analyze the clinical manifestations of acute myocardial infarction(AMI)-like fulminant myocarditis(FM). MethodsThe analysis of characteristics of history, clinical course, and findings of laboratory test and myocardial imaging in eight patients with FM was performed whose findings in electrocardiogram(ECG)were compatible with that of AMI. Results Of all 8 patients, 5 were male, 3 were female. Mean age was 35.5years. All 8 patients had no history of coronary heart disease or diabetes mellitus. Six patients had flu-like symptoms before the onset of FM. Pump failure was seen in all patients 24 hours after admission. The ECG abnormalities were seen in both anterior precordial leads and inferior leads in 5 patients. Singnificant increase in cardiac biomarkers was found in all patients(creatine kinase: 720～7 775 U•L-1; creatine kinase′s isoform: 50～340 U•L-1; Troponin I: 6.0～100 ng•ml-1). Systolic dysfunction was found in all patients(5 patients with left ventricular dilatation)；no regional motion abormality in echocardiography was found in all patients. Emergency agiogramphy was performed in 2 patients and no obvious coronary artery stenosis was observed, intra-aotic balloon counterpulsation is applied in 6 patients, and 7 patients survived. Conclusions Acute myocardial infarction-like fulminant myocarditis is a kind of fatal disease. The analysis of clinical manifestations played an important role in the diagnosis，treatment and prognosis of FM.�
Key words: fulminant myocarditis；acute myocardial infarction；electrocardiography�
(Modern Medical Journal,36:252-254)
近年来，病毒性心肌炎的发病率明显升高，少数病例起病急骤，发展迅速，病情凶险，短时间内可出现严重血流动力学紊乱，甚至导致患者猝死，在临床上称为暴发性心肌炎(FM)。部分FM在心肌酶学和心电图等方面与急性心肌梗死(AMI)非常相似［1］，但两者治疗方法截然不同。AMI的治疗关键是尽快使闭塞的冠状动脉再通，使缺血心肌获得再灌注，而FM需要包括积极的支持治疗在内的综合治疗。因此，充分了解FM的临床特点，早期明确诊断，对改善患者预后有重要的临床意义。�
1 对象和方法�
1.1 研究对象�
我院2004年8月至2007年7月收治酷似AMI的FM患者8例，男5例，女3例，年龄23～53岁，平均35.5岁。所有患者既往均无冠心病、糖尿病病史。6例在发病前有发热、咳嗽等上呼吸道感染症状，主要症状为胸痛者2例，胸闷伴呼吸困难者4例，恶心呕吐者1例，晕厥者1例。所有病例均在入院24 h内(2例在入院时)出现面色苍白、出冷汗、低血压、心源性休克、急性左心衰、肺水肿等泵衰竭表现。入院对象均符合1999年制定的急性心肌炎诊断标准［2］。�
1.2 方法�
对所有患者进行18导联心电图、肌酸激酶、肌酸激酶同工酶、肌钙蛋白Ⅰ、胸片、心脏超声、免疫学、血液生化等检查，2例患者因考虑AMI行急诊冠脉造影术，诊断明确后均给予积极的治疗。�
2 结果�
2.1 辅助检查�
2.1.1 体表心电图特征 所有患者均呈现出AMI样变化，1例在反映前壁的导联上(Vl～V6)出现ST段抬高和异常Q波，2例在反映下壁的导联上(Ⅱ、Ⅲ、aVF)出现ST段抬高及异常Q波，5例在前壁及下壁导联上同时有ST段抬高或异常Q波。7例有窦性心动过速，5例发生短阵室速，1例有Ⅲ度房室传导阻滞，2例发生多源性房速、房颤伴心室率过速。�
2.1.2 心肌损伤标志物检查 所有患者的心肌损伤标志物均显著升高。肌酸磷酸激酶在720～7 775 U•L-1，肌酸磷酸激酶同工酶(MB)在50～340 U•L-1，肌钙蛋白Ⅰ在6.0～100 ng•ml-1(本仪器测定最高值为100 ng•ml-1)。�
2.1.3 心脏超声检查 所有患者均进行了心脏超声检查，心脏结构无明显异常，但收缩功能减退(EF
