综述的基本写作要求——以医学综述范文为例(3)

　　6.预后。
　　
　　影响心肌炎的预后的相关因素：患者的临床表现、临床多项参数及EMB结果。
　　
　　伴有轻度症状及左室射血分数正常的急性心肌炎患儿预后良好，具有较高的自愈率且无后遗症[45].伴有血液动力学改变并早期应用药物或机械辅助支持的暴发性心肌炎患者完全恢复的可能性大于急性心肌炎的患者[46].心肌炎患者伴有心脏结节病（Cardiac sarcoidosis）或巨细胞心肌炎（Giant cell myocarditis）的预后与其早期治疗（应用免疫抑制剂或心脏移植）相关[47].
　　
　　影响MC预后恶化的危险因素较多，包括以下几个因素：晕厥[48]、NYHA分级增高[26]、血清中Fas、Fas配体及IL-10的水平[49]、心电图示QRS间期延长彡120ms[15]、右室收缩功能不全[5°]、肺动脉压的增高[51]、未使用e受体阻断药[52]&EMB示免疫组织化学炎性特征改变[26,45].根据Kindermann等对181位疑似心肌炎患者的研究，发现NYHA分级III级患者或IV级患者、EMB检查示免疫组化结果炎性特征改变及治疗时未使用P受体阻断药的患者预后差[52],患者5年的生存率为39%[26].
　　
　　D'Ambrosio八等[53]对急性心肌炎患者进行随访并分析，发现21%的患儿3年内发展成为扩张性心肌病[54].
　　
　　临床工作中，应当对所有心肌炎患者进行长期随访，随访包括临床评估、心电图及超声心动图，必要时可进行CMR.
　　
　　7.结论。
　　
　　心肌炎是潜在的严重危害生命的疾病，在起病初期，患者随时有猝死的可能。
　　
　　扩张型心肌病合并慢性心力衰竭是心肌炎晚期的主要结局。近年来，对心肌炎的诊断与治疗方面的研究有一点的新进展，无辐射的CMR检查对VMC的诊断有着重大的价值，但是不能够替代心内膜下心肌组织活检。心肌炎的治疗主要是对症辅助支持处理，主要为积极治疗患者休克、心功能的不全及严重的心律失常等综合治疗。因目前缺乏大量的相关临床研究数据，对于心肌炎的诊治仍需进一步探索。
　　
　　参考文献：
　　
　　[1]Baughman KL.Diagnosis of myocarditis: death of Dallas criteria.Circulation2006;113:593-595.
　　[2]Lieberman EB,Hutchins GM,Herskowitz A'et al.Clinicopathologic descriptionof myocarditis J. J Am Coll Cardiol, 1991; 18（7）： 1671-1626.
　　[3]汪翼。小儿暴发性心肌炎的诊断与病原治疗[J].小儿急救医学，2003;10（3）；129-130.
　　[4]Richardson P,McKenna W,Bristow M,et al. Report of the 1995 World HealthOrganization/International Society and Federation of Cardiology Task Force onthe Definition and Classification of Cardiomyopathies.Circulation,1996;93:841-842.
　　[5]中华医学会儿科学会心血管组。病毒性心肌炎诊断标准[J].中华儿科杂志，2000;38（2）：75-76.
　　[6] Nishii M,Inomata T,Takehana H,et al.Serum levels of interleukin-10 onadmission as a prognostic predictor of human fulminant myocarditis. J Am ollCardiol,2004;44:1292-1297.
　　[7] Smith SC,Ladenson JH,Mason JW,et al.Elevations of cardiac troponin Iassociated with myocarditis. Experimental and clinical correlates.Circulation, 1997;95:163-168.
　　[8]Soongswang J,Durongpisitkul K,Nana A,et al.Cardiac troponin T: a marker inthe diagnosis of acute myocarditis in children. Pediatr Cardiol,2005;26:45-49.
　　[9] Dao Q,Krishnaswamy P,Kazanergrar,et al.B-type natriureti. C petide indiagnosis of congestive heart failure in an urgent care setting[J].J AM CollCardiol,2001;37:379-385.
　　[10] Bay M?Kirk V,Pmer J,et al.NT-pro BNP:a new diagnostic screening tool todiffenmfiate bt31woo patients with lloftntd and reduced left ventrieularsystoliction[J].Heart?2003;89（2）： 150-154.
　　[11] Robert D,Harry J,Crijns,et al.Acute viral myocarditis. European HeartJournal,2008;29:2073-2082.
　　[12]Kuhlu,Pauschingerm,Seebergb,et al.Viral persistence in the myocardium isassociated with progressive cardiac dysfunction[J] .Circulation,2005 ; 112（ 13）：1965-1970.
　　[13] Nakashima H,Katayama TJshizaki M,et al.Q wave and non-Q wavemyocarditis with special reference to clinical significance. Jpn Heart J,1998;39:763-774.
　　[14]Magnani JW, Danik HJ,Dec JR, et al. Survival in biopsy-proven myocarditis:a long-term retrospective analysis of the histopathologic,clinical,andhemodynamic predictors[J]. Am Heart J,2006; 151 （2）：463-470.
　　[15] Ukena C5Mahfoud F,Kindermann I,et al.Prognostic electrocardiographicparameters in patients with suspected myocarditis.Eur J Heart Fail,2011;13:398-405.
　　[16] Felker GM,Boehmer JP,Hruban RH,et al.Echocardiographic findings infulminant and acute myocarditis.J Am Coll Cardiol,2000;36:227_232.
　　[17]Abdel-Aty H,Simonetti O,Friedrich MG. T2-weighted cardiovascularmagnetic resonance imaging [J].J Magn Reson Imaging, 2007;26（3）：452-459.
　　[18]Abdel-Aty H,Boye P, Zagrosek A,et al. Diagnostic performance ofcardiovascular magnetic resonance in patients with suspected acute myocarditis:comparison of different approaches. J Am Coll Cardiol, 2005;45:1815-22.
　　[19]Skouri HN,Dec GW,Friedrich MG, et al. Nonivasive imaging in myocarditis.J Am Coll Cardiol, 2006;48（10）：2085-2093.
　　[20]Friedrich MG,Sechtem U,Schulz MJ,et al.Cardiovascular magnetic resonancein myocarditis: a JACC White Paper. J Am Coll Cardiol,2009;53:1475-1487.
　　[21] Mewton N,Liu CY,Croisille P,et al. Assessment of myocardial fibrosis withcardiovascular magnetic resonance. J Am Coll Cardiol, 2011;57（8）：891-903.
　　[22]Zhao SH.Recommendations for CMR in adults with CHD from the respectiveworking groups of the ESC:explanation and viewpoint.Chin J Magn ResonImaging,2010;1,4.
　　[23]Aretz HT. Myocarditis: the Dallas criteria. Hum Pathol, 1987; 18:619-624.
　　[24]Baughman KL.Diagnosis of myocarditisideath of Dallas criteria. Circulation,2006;113:593-595.
　　[25] Yilmaz A,Kindermann I,Kindermann M,et al. Comparative evaluation ofleft and right ventricular endomyocardial biopsy: differences in complication rateand diagnostic performance. Circulation?2010; 122:900-909.
　　[26] Kindermann I, Kindermann M,Kandolf R,et al. Predictors of outcome inpatients with suspected myocarditis. Circulation,2008;l 18:639-648.
　　[27]Dickstein K,Cohen SA,Filippatos G,et al. ESC Guidelines for the diagnosisand treatment of acute and chronic heart failure 2008: the Task Force for theDiagnosis and Treatment of Acute and Chronic Heart Failure 2008 of theEuropean Society of Cardiology. Eur Heart J?2008;29:2388-2442.
　　[28] Matsumori A,Igata H,Ono K,et al.High doses of digitalis increase themyocardial production of proinflammatory cytokines and worsen myocardialinjury in viral myocarditis: a possible mechanism of digitalis toxicity.Jpn CircJ,1999;63:934-940.
　　[29] Reinhartz 0,Hill JD,AlKhaldi A,et al.Thoratec ventricular assist devices inpediatric patients: update on clinical results.Asaio J,2005;51:501-503.
　　[30]Topkara VK,Dang NC,Barili F,et al.Ventricular assist device use for thetreatment of acute viral myocarditis.J Thorac Cardiovasc Surg,2006;131:1190-1191.
　　[31] Mirabel M,Luyt CE, Leprince P, et al Outcomes,long-term quality of life,and psychologic assessment of fulminant myocarditis patients rescued bymechanical circulatory support. Crit Care Med,2011 ;39:1029-1035.
　　[32]Rajagopal SK, Almond CS, Laussen PC,et al. Extracorporeal membraneoxygenation for the support of infants,children, and young adults with acutemyocarditis: a review of the Extracorporeal Life Support OrganizationRegistry.Crit Care Med,2010;38:382-387.
　　[33 ]European Heart Rhythm Association, Heart Rhythm Society, ZIPES D P,et al.ACC/AHA/ESC 2006 guidelines for management of patients with ventriculararrhythmias and the prevention of sudden cardiac death: a report of the AmericanCollege of Cardiology /American Heart Association Task Force and the EuropeanSociety of Cardiology Committee for Practice Guidelines （Writing Committee toDevelop Guidelines for Management of Patients With Ventricular Arrhythmiasand the Prevention of Sudden Cardiac Death）[J].J Am Coll Cardiol,2006;48（5）：247-346.
　　[34 ]McNamara DM,Holubkov R?Starling RC,et al. Controlled trial of intravenousimmune globulin in recent-onset dilated cardiomyopathy .Circulation,2001; 103:2254-2259.
　　[35] Amabile N,Fraisse A,Bouvenot J,et al. Outcome of acute fulminantmyocarditis in children. Heart （British Cardiac Society）， 2006;92:1269-1273.
　　[36] Drucker NA,Colan SD,Lewis AB,et al.Gamma-globulin treatment of acutemyocarditis in the pediatric population. Circulation, 1994;89:252-257.
　　[37]董瑞庆，杨俊华。心肌炎的诊断与治疗现状。新医学，2011;42（2）：71-74.
　　[38] Felix SB,Staudt A?Landsberger M,et al.Removal of cardiodepressantantibodies in dilated cardiomyopathy by immunoadsorption.J Am Coll Cardiol,2002;39:646-652.
　　[39] Doesch AO, Konstandin M, Celik S, et al. Effects of protein Aimmunoadsorption in patients with advanced chronic dilated cardiomyopathy.!Clin Apher, 2009;24:141-149.
　　[40 ]Wang YX, Da CH, Vincelette J, et al. Antiviral and myocyte protective effectsof murine interferon-beta and -{alpha}2 in coxsackievirus B3-induced myocarditisand epicarditis in Balb/c mice. Am J Physiol,2007;293:69-76.
　　[41] Horwitz MS, La CA, Fine C, et al. Pancreatic expression of interferon-gammaprotects mice from lethal coxsackievirus B3 infection and subsequent myocarditis.Nat Med,2000;6:693-697.
　　[42] Okada I, Matsumori A,Matoba Y,et al. Combination treatment with ribavirinand interferon for coxsackievirus B3 replication. J Lab Clin Med,1992; 120:569-573.
　　[43] Matsumori A,Crumpacker CS,Abelmann WH. Prevention of viralmyocarditis with recombinant human leukocyte interferon alpha A/D in a murinemodel. J Am Coll Cardiol,1987;9:1320-1325.
　　[44] Kuhl U,Pauschinger M,Schwimmbeck PL,et al. Interferon-beta treatmenteliminates cardiotropic viruses and improves left ventricular function in patientswith myocardial persistence of viral genomes and left ventricular dysfunction.Circulation,2003;107:2793-2798.
　　[45]Blauwet LA, Cooper LT. Myocarditis. Prog Cardiovasc Dis,2010;52:274-288.
　　[46]McCarthy RE III,Boehmer JP,Hruban RH,et al. Long-term outcome offulminant myocarditis as compared with acute （nonfulminant） myocarditis. N EnglJMed,2000;342:690-695.
　　[47]Singh TP, Rabah R,Cooper LT,et al. Total lymphoid irradiation:newtherapeutic option for refractory giant cell myocarditis. J Heart Lung Transplant,2004;23:492-495.
　　[48]Magnani JW, Dec GW. Myocarditis: current trends in diagnosis and treatment.Circulation,2006;l 13:876-890.
　　[49]Sheppard R, Bedi M, Kubota T,et al. Myocard ial express ion of fas andrecovery of left ventxicu lar function in pat ien tsw ith recen t- on setcardiomyopathy [J], J Am Coll Cardiol,2005;46（6）： 1043-1044.
　　[50] Mendes LA, Dec GW, Picard MH,et al: Right ventricular dysfunction: anindependent predictor of adverse outcome in patients with myocarditis. Am HeartJ,1994;128:301-307.
　　[51]McCarthy RE, Boehmer JP, Hruban RH, et al. Long-term outcome offulminant myocarditis as compared with acute （nonfulminant） myocarditis. N EnglJ Med,2000;342:690-695.
　　[52] Mason JW, O'Connell JB,Herskowitz A,et al. A clinical trial ofimmunosuppressive therapy for myocarditis. The Myocarditis Treatment TrialInvestigators. N Engl J Med,1995;333:269-275.
　　[53] D'Ambrosio A,Patti G, Manzoli A,et al. The fate of acute myocarditisbetween spontaneous improvement and evolution to dilated cardiomyopathy: areview. Heart52001 ;85:499-504.
　　[54] Blauwet LA,Cooper LT.Myocarditis. Progress in Cardiovascular Diseases,2010;52:274-288.