呼吸道合胞病毒和人偏肺病毒感染的的心脏并发症：系统综述及临床特征汇总分析。
完整摘要 · 中文译文
呼吸道合胞病毒（RSV）和人类偏肺病毒（hMPV）是不同年龄组呼吸道感染的主要原因。尽管主要被视为呼吸道病原体，但两种病毒均与心脏并发症相关，其临床表现谱尚未完全阐明。我们系统性地回顾了已发表的RSV和hMPV相关心脏受累病例，并比较了其临床特征和结局。系统检索了PubMed、Scopus和EMBASE，以获取描述经实验室确诊的RSV或hMPV感染相关心脏并发症的报告。汇总个体患者数据，并使用描述性和单变量分析进行分析。使用多变量逻辑回归识别与hMPV相比RSV诊断相关的特征，同时进行多重对应分析（MCA）以探索临床表现的多变量模式。另外进行了按年龄分层的敏感性分析。总共纳入102例病例，包括71例RSV（69.6%）和31例hMPV（30.4%）。hMPV病例的年龄显著大于RSV病例（41.5岁，四分位间距3.5-63.0对1.5岁，四分位间距0.2-31.0；p < 0.001），且合并症负担更高。心肌炎是两组中最常报告的心脏并发症（hMPV 87.1%对RSV 74.6%），其次是心力衰竭和心包炎。hMPV病例的ICU入住率更高（96.8%对77.5%；p = 0.034），而总体临床结局在两组之间无显著差异。 在探索性多变量分析中，呼吸困难（校正后比值比 16.280，95% 置信区间 1.370-193.475）和咳嗽（校正后比值比 6.059，95% 置信区间 1.062-34.552）与人偏肺病毒（hMPV）诊断相关，而流涕（校正后比值比 0.031，95% 置信区间 0.003-0.286）和嗜睡/精神状态改变（校正后比值比 0.103，95% 置信区间 0.015-0.712）与呼吸道合胞病毒（RSV）诊断相关。重症监护病房（ICU）入住也与 hMPV 诊断相关（校正后比值比 11.033，95% 置信区间 1.125-108.173）。这些估计值具有较宽的置信区间，应谨慎解读。多类别分析（MCA）显示 RSV 和 hMPV 病例之间存在显著重叠，其总体临床表现未见明确区分，而大多数组间差异在按年龄分层的分析中有所减弱。总之，RSV 和 hMPV 均可能与广泛潜在严重的心脏并发症相关，其中心肌炎是报道的主要表现。尽管在人口统计学和临床特征上存在一些差异，但其总体心脏和临床表型显著重叠。这些发现支持在重症 RSV 和 hMPV 感染期间提高对潜在心脏受累的认识，同时强调需要开展前瞻性、系统性调查的队列研究，以确定这些并发症的发生率、机制和长期结局。
完整摘要 · 英文原文
Respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) are major causes of respiratory tract infections across different age groups. Although primarily regarded as respiratory pathogens, both viruses have been associated with cardiac complications, whose clinical spectrum remains incompletely characterized. We systematically reviewed published cases of RSV- and hMPV-associated cardiac involvement and compared their clinical characteristics and outcomes. PubMed, Scopus, and EMBASE were systematically searched for reports describing cardiac complications associated with laboratory-confirmed RSV or hMPV infection. Individual patient data were pooled and analyzed using descriptive and univariate analyses. Multivariable logistic regression was used to identify characteristics associated with hMPV versus RSV diagnosis, while multiple correspondence analysis (MCA) was performed to explore multivariate patterns of clinical presentation. Age-stratified sensitivity analyses were additionally performed. Overall, 102 cases were included, comprising 71 RSV (69.6%) and 31 hMPV (30.4%). hMPV cases were significantly older than RSV cases (41.5 years, interquartile range 3.5-63.0 vs. 1.5 years, interquartile range 0.2-31.0; p < 0.001) and had a higher burden of comorbidities. Myocarditis was the most frequently reported cardiac complication in both groups (87.1% hMPV vs. 74.6% RSV), followed by heart failure and pericarditis. ICU admission was more frequent among hMPV cases (96.8% vs. 77.5%; p = 0.034), whereas overall clinical outcomes did not significantly differ between groups. In exploratory multivariable analyses, dyspnea (aOR 16.280, 95% CI 1.370-193.475) and cough (aOR 6.059, 95% CI 1.062-34.552) were associated with hMPV diagnosis, whereas rhinorrhea (aOR 0.031, 95% CI 0.003-0.286) and lethargy/altered mental status (aOR 0.103, 95% CI 0.015-0.712) were associated with RSV diagnosis. ICU admission was also associated with hMPV diagnosis (aOR 11.033, 95% CI 1.125-108.173). These estimates were characterized by wide confidence intervals and should be interpreted cautiously. MCA showed substantial overlap between RSV and hMPV cases, without clear separation of their overall clinical presentation, while most between-group differences were attenuated in age-stratified analyses. In conclusion, both RSV and hMPV can be associated with a broad spectrum of potentially severe cardiac complications, with myocarditis representing the predominant reported manifestation. Despite some differences in demographic and clinical characteristics, their overall cardiac and clinical phenotypes substantially overlap. These findings support greater awareness of potential cardiac involvement during severe RSV and hMPV infections, while highlighting the need for prospective, systematically investigated cohorts to establish the incidence, mechanisms, and long-term outcomes of these complications.