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Abstract：
Objectives: Fulminant myocarditis (FM) is a rapidly progressive and frequently fatal form of myocarditis that has been difficult to classify. This study aims to compare the clinical characteristics, treatments and outcomes in patients with fulminant giant cell myocarditis (FGCM) and fulminant lymphocytic myocarditis (FLM). Methods and Results: In our retrospective study, nine patients with FGCM (mean age 47.9 ± 7.5 years, six female) and 7 FLM (mean age 42.1 ± 12.3 years, four female) patients confirmed by histology in the last 11 years were included. Most patients with FGCM and FLM were NYHA functional class IV (56 vs. 100%, p = 0.132). Patients with FGCM had significantly lower levels of high-sensitivity C-reactive protein [hs-CRP, 4.4 (2.0-10.2) mg/L vs. 13.6 (12.6-14.6) mg/L, P = 0.004, data shown as the median with IQR], creatine kinase-myoglobin [CK-MB, 1.4 (1.0-3.2) ng/ml vs. 14.6 (3.0-64.9) ng/ml, P = 0.025, median with IQR], and alanine aminotransferase [ALT, 38.0 (25.0-61.5) IU/L vs. 997.0 (50.0-3,080.0) IU/L, P = 0.030, median with IQR] and greater right ventricular end-diastolic diameter (RVEDD) [2.9 ± 0.3 cm vs. 2.4 ± 0.6 cm, P = 0.034, mean ± SD] than those with FLM. No differences were observed in the use of intra-aortic balloon pump (44 vs. 43%, p = 1.000) and extracorporeal membrane oxygenation (11 vs. 43%, p = 0.262) between the two groups. The long-term survival rate was significantly lower in FGCM group compared with FLM group (0 vs. 71.4%, p = 0.022). A multivariate cox regression analysis showed the level of hs-CRP (hazard ratio = 0.871, 95% confidence interval: 0.761-0.996, P = 0.043) was an independent prognostic factor for FM patients. Furthermore, the level of hs-CRP had a good ability to discriminate between patients with FGCM and FLM (AUC = 0.94, 95% confidence interval: 0.4213-0.9964). Conclusions: The inflammatory response and myocardial damage in the patients with FGCM were milder than those with FLM. Patients with FGCM had distinctly poorer prognoses compared with those with FLM. Our results suggest that hs-CRP could be a promising prognostic biomarker and a hs-CRP level of 11.71 mg/L is an appropriate cutoff point for the differentiating diagnosis between patients with FGCM and FLM.
摘要：
目的：暴发性心肌炎（FM）是一种快速进展且经常致命的心肌炎形式，难以分类。本研究旨在比较临床特点,暴发性巨细胞心肌炎（FGCM）和暴发性淋巴细胞性心肌炎（FLM）患者的治疗和结局。方法和结果：在我们的回顾性研究中，9例FGCM患者（平均年龄47.9±7.5岁，6名女性）和7名FLM（平均年龄42.1±12.3岁，包括在过去11年中通过组织学证实的四名女性）患者。大多数FGCM和FLM患者为NYHA功能IV级（56vs.100%,p=0.132）。FGCM患者高敏C反应蛋白[hs-CRP,4.4（2.0-10.2）mg/Lvs.13.6(12.6-14.6)mg/L,P=0.004，数据显示为IQR的中位数]，肌酸激酶-肌红蛋白[CK-MB，1.4（1.0-3.2）ng/ml与14.6（3.0-64.9）ng/ml，P=0.025，中位数与IQR]，和丙氨酸氨基转移酶[ALT，38.0(25.0-61.5)IU/Lvs.997.0(50.0-3,080.0)IU/L,P=0.030，IQR中位数]和更大的右心室舒张末期直径（RVEDD）[2.9±0.3cmvs.2.4±0.6cm,P=0.034，平均值±SD]。在使用主动脉内球囊泵方面没有观察到差异（44vs.43%,p=1.000)和体外膜氧合(11vs.43%,两组之间p=0.262）。FGCM组的长期生存率明显低于FLM组（0。71.4%,p=0.022)。多因素cox回归分析显示，hs-CRP水平（风险比=0.871，95%置信区间：0.761～0.996，P=0.043）是FM患者的独立预后因素。此外，hs-CRP水平具有很好的区分FGCM和FLM患者的能力（AUC=0.94，95％置信区间：0.4213-0.9964）。结论：FGCM患者的炎症反应和心肌损伤较FLM患者轻。与FLM患者相比，FGCM患者的预后明显较差。我们的结果表明，hs-CRP可能是一个有希望的预后生物标志物，而11.71mg/L的hs-CRP水平是FGCM和FLM患者之间鉴别诊断的适当临界点。
