ABSTRACT
Objective:To investigate the risk factors of fulminant myocarditis in children.Methods:The clinical data of 67 children with clinical diagnosis of viral myocarditis from January 2015 to December 2018 in our hospital were retrospectively analyzed.The children were divided into fulminant myocarditis group( n=13)and common myocarditis group( n=54). The clinical data of gender, age, history of pre-infection, clinical manifestations, laboratory tests, electrocardiogram, echocardiography, and imaging findings were compared between the two groups.The multiple Logistic regression analysis was used to identify the independent risk factors of fulminant myocarditis. Results:(1)Seven cases(53.8%)died in the fulminant myocarditis group, 4 cases(30.8%) of them died within 24 hours after admission, and all the children in the common myocarditis group improved and discharged.(2)The incidences of facial cyanosis, abdominal distension, convulsions, and chills were higher in the fulminant myocarditis group than those in the common myocarditis group( P<0.05). (3)The level of creatinekinase-MB, lactate dehydrogenase, α-hydroxybutyric dehydrogenase and aspartate transferase in the fulminant myocarditis group were higher than those in the common myocarditis group( P<0.05). (4)On electrocardiogram, QRS wave duration in the fulminant myocarditis group was longer than that in the common myocarditis group[118(82, 127)ms vs.62(62, 122)ms, P<0.05]. The incidences of ventricular tachycardia in the fulminant myocarditis group was higher than that in the common myocarditis group( P<0.05). (5)In the fulminant myocarditis group, the incidences of left ventricular ejection fraction(LVEF)decreased, the left ventricular short axis fraction shortening(LVFS), and the incidence of left ventricular enlargement were higher than those in the common myocarditis group[92.3%(12/13)vs.18.5%(10/54), 84.6%(11/13)vs.9.3%(5/54), 76.9%(10/13)vs.13.0%(7/54), P<0.05]. Chest X-ray examination of the fulminant myocarditis group showed that the incidences of heart shadow enlargement and pulmonary blood stasis were higher than those in the common myocarditis group( P<0.05). (6)Multiple Logistic regression analysis revealed that LVEF reduction( OR=19.015, 95% CI 1.456-248.348, P=0.025), LVFS reduction( OR=18.691, 95% CI 2.062-169.453, P=0.009)and prolonged QRS wave duration( OR=1.040, 95% CI 1.001-1.082, P=0.046) were independent risk factors for fulminant myocarditis. Conclusion:The early mortality of fulminant myocarditis is high in children, and the LVEF reduction, LVFS reduction and prolonged QRS wave duration are independent risk factors for fulminant myocarditis.
ABSTRACT
Objective To explore the effects of combining tumor necrosis factor-α (TNF-αt) inhibitor with adenosine A2b receptor antagonist CVT-6883 on asthmatic lung irflammation in mice.Methods A total of 40 female Balb/c mice were evenly randomized into 5 groups,including normal control group,asthma group,CVT-6883 group,CVT-6883 + etanercept group,and etanercept group.The pathological changes in the lungs were determined and the number of white blood cells(WBC) and eosinophil(EOS) in the bronchoalveolar lavage fluid(BALF) was counted by cell count in each group.The levels of TNF-α in BALF were evaluated by enzyme-linked immunosorbent assay (ELISA).The expression of adenosine A2b receptor mRNA in the lung tissues were measured by reverse transcriptionpolymerase chain reaction (RT-PCR).Results 1.The lung tissue in asthma group,dyed by HE,was found to have a large number of airway inflammatory cell infiltration,thickening of the bronchial mucosa,the alveolar septa widened and fracture.In the CVT-6883,CVT-6883 + etanercept and etanercept group,the pathological changes were relieved.2.The WBC and EOS counts in BALF of the asthma group[(413.8 ±5.8)/L,(139.3 ± 1.4)/L] were higher than those of the normal control group [(24.0 ± 1.3)/L,(1.8 ± 0.1)/L,P ＜ 0.05].The WBC and EOS counts of the CVT-6883 group[(111.5 ±3.8)/L,(3.3 ±0.1)/L],the etanercept group + the CVT-6883 group[(173.8 ±3.9)/L,(10.4 ± 0.2)/L],and the etanercept group[(138.4 ± 3.0)/L,(4.1 ± 0.1)/L] were lower than those of the asthma group (P ＜0.05).3.Compared with the control group(100.4 ± 5.7) ng/L,the TNF-α concentration of the asthma group (145.2 ± 8.8) ng/L was significantly higher (P ＜ 0.05) ; the TNF-α concentration of CVT-6883 group (130.9 ± 5.9) ng/L,CVT-6883 + etanercept group(115.7 ± 8.2) ng/L and the etanercept group(122.0 ± 8.7) ng/L,were significantly decreased compared with asthma group (P ＜ 0.05).4.In asthma group (8.9 ± 1.1) compared with the control group(0.6 ± 0.2),the A2bAR (adenosine A2b receptor) mRNA expression was upregulated (P ＜ 0.05) ; CVT-6883 group(1.6 ±0,3),CVT-6883 + etanercept group(2.5 ±0.6) and the etanercept group(5.3 ±0.4),the A2bAR(adenosine A2b receptor) mRNA expression was significantly decreased compared with asthma group (all P ＜0,05).Conclusion Combination of TNF-α inhibitor with adenosine A2b receptor antagonist can reduce asthmatic lung inflammation.
