新路易斯湖标准在儿童心肌炎中的应用价值研究

doi:10.12372/jcp.2024.23e0289

Abstract

Abstract:

Objective To explore the application value of new Lake Louise criteria (LLC) in the diagnosis of myocarditis in children. Methods The clinical data of children diagnosed with myocarditis (myocarditis group) in Children's Hospital Affiliated to Zhejiang University School of Medicine from May 2019 to December 2020 were retrospectively analyzed. In addition, children who were clinically excluded from myocarditis during the same period were included as non-myocarditis group. Receiver operating characteristic (ROC) curve analysis and calculation of Kappa value were used to compare the diagnostic efficacy of LLC and new LLC in children with myocarditis. Results In the myocarditis group, there were 29 children (16 boys and 13 girls) with a median age of 8.8 (4.2-13.4) years. There were 50 patients (27 boys and 23 girls) in the non-myocarditis group, and the median age was 9.7 (6.2-13.2) years. The T2 mapping value, T1 native value and ECV value of myocarditis group were higher than those of non-myocarditis group, the T1 enhanced value was lower than that of non-myocarditis group, and the difference was statistically significant (P<0.05). The area under ROC curves (AUCs) of LLC, T2 mapping, T1 native, T1 enhanced and ECV for diagnosing myocarditis were 0.75, 0.86, 0.92, 0.70 and 0.93, respectively. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of LLC in diagnosing myocarditis were 81.0%, 51.7%, 98.0%, 93.8%, 77.8%, 25.85 and 0.49 respectively. The consistency between LLC and the clinical diagnosis of myocarditis was moderate (Kappa=0.55, P<0.001). The accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of new LLC in diagnosing myocarditis were 92.4%, 89.7%, 94.0%, 89.7%, 94.0%, 14.95 and 0.11 respectively. The consistency between new LLC and the clinical diagnosis of myocarditis was good (Kappa=0.84, P<0.001). Conclusions The new LLC has good application value in the diagnosis of myocarditis in children and can effectively improve the diagnostic efficiency.

Key words: new Lake Louise criteria, myocarditis, magnetic resonance, child

LIANG Jiawei, MA Xiaohui, JIA Xuan. Study on the application value of the new Lake Louise criteria in children with myocarditis[J].Journal of Clinical Pediatrics, 2024, 42(6): 526-532.

Figures/Tables 5

References 39

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组别	例数	年龄[M(P₂₅~P₇₅)]/岁	男性[n(%)]	HCT(x±s)/%	心率(x±s)/次·min^-1	ER(x±s)
心肌炎组	29	8.8(4.2~13.4)	16(55.2)	37.4±5.1	84.6±30.9	2.0±0.5
非心肌炎组	50	9.7(6.2~13.2)	27(54.0)	37.9±3.1	79.7±16.8	1.6±0.2
统计量		Z=0.90	χ²=0.01	t=0.49	t=0.79	t=4.20
P		0.373	0.920	0.626	0.435	<0.001

组别	例数	T2 mapping值/ms	T1 native值/ms	T1 enhanced值/ms	ECV/%
心肌炎组	29	60.0±9.5	1 185.7±102.7	469.3±80.2	36.5±7.1
非心肌炎组	50	49.5±5.5	1 027.4±28.8	530.9±64.7	26.4±3.3
t值		5.43	8.12	3.73	7.21
P		<0.001	<0.001	<0.001	<0.001

项目	AUC(95%CI)	P	截断值	灵敏度/%	特异度/%	约登指数
LLC	0.75(0.64~0.84)	<0.001	-	51.7	98.0	0.50
T2 mapping	0.86(0.77~0.93)	<0.001	52.5 ms	79.3	80.0	0.59
T1 native	0.92(0.84~0.97)	<0.001	1 086.0 ms	82.8	100.0	0.83
T1 enhanced	0.70(0.59~0.80)	<0.001	516.5 ms	79.3	54.0	0.33
ECV	0.93(0.85~0.98)	<0.001	30.4%	89.7	96.0	0.86

项目	准确度/%	灵敏度/%	特异度/%	阳性预测值/%	阴性预测值/%
LLC	81.0	51.7	98.0	93.8	77.8
新LLC	92.4	89.7	94.0	89.7	94.0
χ²值	4.45	10.07	1.04	0.00	5.74
P	0.035	0.002	0.307	1.000	0.017

Study on the application value of the new Lake Louise criteria in children with myocarditis

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