小儿病毒性心肌炎ViralMyocarditisinChildren一、概述(GeneralConsiderations)•病毒性心肌炎由病毒侵犯心脏导致的以心肌局灶性或弥漫性炎性病变为主要表现的心脏疾病，有时病变也可累及心内膜或心包。•Theviralmyocarditisisacommonacguiredheartdisease.It’smainmanifestationsarethefocalordiffuseinflammationinthemyocardium,whichiscausedbyvirusestooffendtheheart.Theinflammationcouldinvolvetheendocardiumorpericardiumoccasionally.•病理特征为间质性炎性细胞浸润、心肌变性及坏死。•Thepathologicalcharactersaretheinterstitialinflammatorycellinfiltration,myocardialdegenerationandnecrosis.其临床表现取决于患儿的年龄：It’smanifestationsaretosomedegreeagedependent:•在小婴儿，常呈急性暴发性起病；•inearlyinfancy,viralmyocarditisoftenoccursasanacute,fulminantdisease;•在幼儿及学龄儿童，常急性起病，但较少表现为暴发性心肌心包炎；•intoddlersandyoungchildren,itoccursasanacute,butlessfulminantmyopericarditis;•在年长儿和青少年，症状不明显，至慢性期形成扩张型心肌病方被发现。•inolderchildrenandadolescents,itisoftenasymptomaticandcomestoclinicalattentionprimarilyasaprecursortoidiopathicdilatedcardiomyopathy.•少数患儿在急性期死于急性心力衰竭或严重的心律失常，或在慢性期死于慢性心力衰竭或心律失常；多数患儿预后良好。•Afewofthechildrencoulddiedfromtheacuteheartfailureortheseverearrhythmiaintheacuteperiod,orthechroniccardiacfailureandthearrhythmiainthechronicperiod.Mostofthesickchildrenhadagoodprognosis.•典型病例在发病前数日或2周内有呼吸道或肠道感染病史。•Inthetypicalcases,thechildrencouldhavetherespiratoryorintestinalviralinfectionbeforetheseveraldaysorinthe2wkoftheonset.二、病因及发病机制(EtiologyandPathogenesis)•常见病毒有柯萨奇病毒（柯萨奇B3病毒最多见）、埃可病毒、脊髓灰质炎病毒、呼吸道合胞病毒、腺病毒、传染性肝炎病毒、流感和副流感病毒、麻疹病毒、单纯疱疹病毒及流行性腮腺炎病毒等。•ThemostcommoncausativeagentsinchildrenarecoxsackievirusB,echovirus,poliovirus,respiratorysyncytialviruse,adenovirus,infectioushepatitisvirus,influenzaandparainfluenzavirus,measlesvirus,herpessimplexvirusandepidemicparotitisvirus.•其他病毒如风疹病毒、水痘-带状疱疹病毒、巨细胞病毒、传染性单核细胞增多症病毒（EB病毒）、肠道EV71病毒及艾滋病病毒等也可导致心肌炎。•Otherviruses,suchasrubellavirus,varicella-herpeszostervirus,cytomegalovirus,EBV,EV71andHIV,couldalsocausemyocarditis.病毒性心肌炎的病毒演变（Mayaclinproc,2009）19481950s1990s20002007CVBEnterovirusAdenovirusPVB19HCVCVAHHV6EBVEnterovirusmyocarditisNonenterovirusmyocarditis本病的发病机制不完全清楚。•急性期——病毒直接损害心肌细胞•迁延期及慢性期——异常细胞和体液免疫反应→心肌细胞受损病毒直接损害和异常的免疫反应→心肌细胞变性、坏死、心肌发生纤维化→心力衰竭、心律失常及心脏扩大等。•Thepathogenesisoftheviralmyocarditisisnotclearcompletely.Theclinicalresearchandanimalexperimentrevealedthatthevirusescoulddamagethecardiacmyocytesdirectlyintheacuteperiod,andinducetheabnormalcellularandfluidimmuneresponse,suchastheanti-myocardialantibody,IL-Ia,TNFa,r-INF,whichinjuredthemyocardiuminthelagandchronicphase.Thevirusesandtheabnormalimmunereponseresultedinthecelldegenerationandnectosis,andsubsequentfibrosiswhichcausedtheheartfailure,arrhythmiaandcardiacdilatation.病因及发病机制VMC时程（分期）VMC时程（分期）三、临床表现(ClinicalManifestations)•病毒性心肌炎患儿的症状及体征轻重不一，取决于患儿的年龄及疾病的不同时期。•Thesymptomsandsignsdependonthepatient’sageandtheacuteorchronicnatu...
