rospedРоссийский педиатрический журнал имени М.Я. СтуденикинаM.Ya. Studenikin Russian Pediatric JournalФГАУ «НМИЦ здоровья детей» Минздрава России10.46563/1560-9561-2024-27-5-385-393smbpcrrosped-1066Research ArticleОБЗОРЫREVIEWSМиокардиты у детей. Современные аспекты диагностикиMyocarditis in children. Modern aspects of diagnosticshttps://orcid.org/0000-0001-7336-4102ВасичкинаЕлена СергеевнаVasichkinaElena S.

Доктор мед. наук, зав. НИЦ неизвестных, редких и генетически обусловленных заболеваний, проф. каф. детских болезней ФГБУ «НМИЦ им. В.А. Алмазова» Минздрава России

e-mail: vasichkinalena@mail.ru

MD, PhD, DSc, Head, Research Center for Unknown, Rare and Genetically Caused Diseases, prof. of the Department of children’s diseases, National Medical Research Center named after V.A. Almazov

e-mail: vasichkinalena@mail.ru

vasichkinalena@mail.ruhttps://orcid.org/0000-0002-2290-0013БалыковаЛариса АлександровнаBalykovaLarisa A.

Доктор мед. наук, проф., член-корр. РАН, директор Медицинского института ФГБОУ ВО «МГУ им. Н.П. Огарева»

e-mail: larisabalykova@yandex.ru

larisabalykova@yandex.ruhttps://orcid.org/0000-0002-0144-2885БасаргинаЕлена НиколаевнаBasarginaElena N.

Доктор мед. наук, проф., гл. науч. сотр., лаб. разработки новых технологий диагностики и лечения болезней детского возраста, зав. кардиологическим отделением, ФГАУ «НМИЦ здоровья детей» Минздрава России

e-mail: basargina@nczd.ru

basargina@nczd.ruhttps://orcid.org/0000-0002-7668-1282БрегельЛюдмила ВладимировнаBregelLyudmila V.

Доктор мед. наук, проф., зав. научным центром, главный внештатный детский специалист ревматолог Минздрава Иркутской области, зав. каф. педиатрии, ИГМАПО — филиала ФГБОУ ДПО РМАНПО Минздрава России

e-mail: loudmilabregel@yandex.ru

loudmilabregel@yandex.ruhttps://orcid.org/0000-0002-3219-2145ДегтяреваЕлена АлександровнаDegtyarevaElena A.

Доктор мед. наук, проф., зав. каф. детской кардиологии факультета последипломного образования, ФГАОУ ВО РУДН, Медицинский институт

e-mail: dgp48@yandex.ru

dgp48@yandex.ruhttps://orcid.org/0000-0001-8195-5682КовалевИгорь АлександровичKovalevIgor A.

Доктор мед. наук, проф., зам. директора по лечебной работе, зав. отделом детской кардиологии и аритмологии «НИКИ педиатрии им. акад. Ю.Е. Вельтищева» РНИМУ им. Н.И. Пирогова

e-mail: igor.kovalev64@mail.ru

igor.kovalev64@mail.ruhttps://orcid.org/0000-0001-6776-2614КотлуковаНаталья ПавловнаKotlukovaNataliya P.

Доктор мед. наук, проф. каф. госпитальной педиатрии № 1 педиатрического факультета ГБОУ ВПО «РНИМУ им. Н.И. Пирогова»

e-mail: natali130@yandex.ru

natali130@yandex.ruhttps://orcid.org/0000-0002-5273-6859ЛеонтьеваИрина ВикторовнаLeontyevaIrina V.

Доктор мед. наук, проф., гл. науч. сотр. отдела детской кардиологии и аритмологии НИКИ педиатрии им. акад. Ю.Е. Вельтищева «РНИМУ им. Н.И. Пирогова» Минздрава России

e-mail: lirina2006@mail.ru

lirina2006@mail.ruhttps://orcid.org/0000-0001-7362-2685ЯковлеваЛюдмила ВикторовнаYakovlevaLyudmila V.

Доктор мед. наук, проф., зав. каф. поликлинической и неотложной педиатрии с курсом ИДПО

e-mail: fock20051@mail.ru

fock20051@mail.ruhttps://orcid.org/0000-0002-7511-3240ГрозноваОльга СергеевнаGroznovaOlga S.

Доктор мед. наук, проф., гл. науч. сотр. отдела детской кардиологии и аритмологии НИКИ педиатрии им. акад. Ю.Е. Вельтищева

e-mail: ogroznova@gmail.com

ogroznova@gmail.comФГБУ «Национальный медицинский исследовательский центр им. В.А. Алмазова» Минздрава РоссииNational Medical Research Center named after V.A. AlmazovФГБОУ ВО «Национальный исследовательский Мордовский государственный университет им. Н.П. Огарева»National Research Mordovian State University named after N.P. OgarevФГАУ «Национальный медицинский исследовательский центр здоровья детей» Минздрава РоссииNational Medical Research Center for Children’s HealthИркутская государственная медицинская академия последипломного образования — филиал ФГБОУ ДПО «Российская медицинская академия непрерывного последипломного образования» Минздрава РоссииIrkutsk State Medical Academy of Postgraduate Education — branch of the Russian Medical Academy of Continuous Professional EducationФГАОУ ВО «Российский университет дружбы народов им. Патриса Лумумбы»Russian University of People FriendshipФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииN.I. Pirogov Russian National Research Medical UniversityФГБО УВО «Башкирский государственный медицинский университет» Минздрава РоссииBashkir State Medical UniversityФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииN.I. Pirogov Russian National Research Medical University; Charity Fund for Medical and Social Genetic Assistance Projects «Genome of Life»202414112024275385393Copyright © Васичкина Е.С., Балыкова Л.А., Басаргина Е.Н., Брегель Л.В., Дегтярева Е.А., Ковалев И.А., Котлукова Н.П., Леонтьева И.В., Яковлева Л.В., Грознова О.С., 20242024Васичкина Е.С., Балыкова Л.А., Басаргина Е.Н., Брегель Л.В., Дегтярева Е.А., Ковалев И.А., Котлукова Н.П., Леонтьева И.В., Яковлева Л.В., Грознова О.С.Vasichkina E.S., Balykova L.A., Basargina E.N., Bregel L.V., Degtyareva E.A., Kovalev I.A., Kotlukova N.P., Leontyeva I.V., Yakovleva L.V., Groznova O.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rosped.ru/jour/article/view/1066

Миокардит — это острое или хроническое воспалительное заболевание миокарда, характеризующееся многообразием клинических проявлений, неспецифичностью симптомов и физикальных данных, недостаточным числом информативных диагностических тестов, которое является вызовом для практикующих врачей на всех этапах оказания медицинской помощи. Цель обзора: всесторонне представить особенности клинической диагностики миокардитов у детей.

Наличие миокардита следует предполагать в ситуациях, когда у детей, независимо от возраста, впервые появились симптомы сердечной недостаточности, а также при наличии клиники вирусных инфекций, сопровождающейся респираторными или абдоминальными симптомами, в совокупности с развитием тахикардии, гипотонии или нарушений сердечного ритма, даже при отсутствии кардиомегалии. Следует клинически заподозрить миокардит на этапе, когда должны быть приняты необходимые решения о маршрутизации больного, формировании комплекса диагностических обследований и старте терапии. Магнитно-резонансная томография сердца является сегодня неинвазивным золотым стандартом диагностики миокардита и позволяет выявить миокардит в течение 2–3 нед после появления первых симптомов. Для точной морфологической диагностики миокардита у детей может быть использована эндомиокардиальная биопсия. Значимыми для диагностики миокардитов у детей являются молекулярно-биологические и генетические исследования, определяющие тяжесть течения и исход заболевания.

Заключение

Заключение. На основании данных литературы и собственного опыта диагностики миокардитов авторами разработан оригинальный диагностический алгоритм принятия врачебного решения при подозрении на острый миокардит у детей.

Участие авторов

Участие авторов: Васичкина Е.С. — концепция и дизайн исследования; Васичкина Е.С., Балыкова Л.А., Басаргина Е.Н., Брегель Л.В., Дегтярева Е.А., Ковалаев И.А., Котлукова Н.П., Леонтьева И.В., Яковлева Л.В., Грознова О.С. — сбор и обработка материала; Васичкина Е.С., Ковалев И.А., Котлукова Н.П., Леонтьева И.В. — написание текста; Балыкова Л.А., Басаргина Е.Н., Брегель Л.В., Дегтярева Е.А., Яковлева Л.В., Грознова О.С. — редактирование. Все соавторы — утверждение окончательного варианта статьи, ответственность за целостность всех частей статьи.

Финансирование

Финансирование. Исследование не имело финансовой поддержки.

Конфликт интересов

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

Поступила 12

Поступила 12.09.2024Принята к печати 08.10.2024Опубликована 12.11.2024

Introduction

Introduction. A review of the current literature on the features of the diagnosis of myocarditis in children is presented. Myocarditis is an acute or chronic inflammatory myocardial disease characterized by a variety of clinical manifestations, nonspecific symptoms and physical data. With insufficient number of informative diagnostic tests, there is a challenge for practitioners at all stages of medical care. Aim of the review is to comprehensively present the features of the clinical diagnosis of myocarditis in children. The presence of myocarditis should be assumed in situations where children, regardless of the age, first developed symptoms of heart failure (HF), as well as in the presence of a clinic of viral infections accompanied by respiratory or abdominal symptoms, combined with the development of tachycardia, hypotension or cardiac arrhythmias, even in the absence of cardiomegaly. Myocarditis should be clinically suspected at the stage when the necessary decisions should be made about the patient’s routing, the formation of a complex of diagnostic examinations and the start of therapy. Magnetic resonance imaging (MRI) of the heart is today the non-invasive gold standard for the diagnosis of myocarditis that allows detecting myocarditis within 2–3 weeks after the first symptoms appear. Endomyocardial biopsy can be used for accurate morphological diagnosis of myocarditis in children. Molecular biological and genetic studies that determine the severity and outcome of the disease are important for the diagnosis of myocarditis in children.

Conclusion

Conclusion. Based on the literature data and own experience in diagnosing myocarditis, the authors have developed an original diagnostic algorithm to make the right medical decision in case of suspected acute myocarditis in children.

Contribution

Contribution: Vasichkina E.S. — concept and design of the study; Vasichkina E.S., Balykova L.A., Basargina E.N., Bregel L.V., Degtyareva E.A., Kovalev I.A., Kotlukova N.P., Leontyeva I.V., Yakovleva L.V., Groznova O.S. — collection and processing of material; Vasichkina E.S., Kovalev I.A., Kotlukova N.P., Leontyeva I.V. — writing the text; Balykova L.A., Basargina E.N., Bregel L.V., Degtyareva E.A., Yakovleva L.V., Groznova O.S. — editing the text. All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment

Acknowledgment. The study had no sponsorship.

Conflict of interest

Conflict of interest. The authors declare no conflict of interest.

Received

Received: September 12, 2024Accepted: October 08, 2024Published: November 12, 2024

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The authors declare that there are no conflicts of interest present.