轮状病毒感染患儿肌酸激酶同工酶动态变化及其对心肌损害的诊断价值  

Dynamic variation of creatine kinase MB isoenzymes and diagnostic value of myocardial damage in ;children with rotavirus diarrhea

作　　者：施学文 陈向前 殷铭东 曹青 

机构地区：[1]江苏省泗洪儿童医院感染科,223900

出　　处：《国际儿科学杂志》2015年第4期464-467,共4页International Journal of Pediatrics

摘　　要：目的：探讨肌酸激酶心肌同工酶（ creatine kinase MB isoenzymes, CK-MB）在轮状病毒感染中的动态变化规律,并分析CK-MB/CK对于心肌损害的诊断价值。方法对2010年5月至2013年12月在江苏省泗洪儿童医院儿童感染科住院轮状病毒感染伴有CK-MB升高的患儿的临床表现、实验室检查结果以及临床经过进行回顾性分析。患者分为无心肌损害组和心肌损害组,比较两组患者CK-MB动态变化规律。在无心肌损害组中,对采用营养心肌治疗和常规治疗患儿的CK-MB变化进行对比分析；采用受试者操作特征曲线分析CK-MB/CK对心肌损害的预测价值。结果符合纳入标准的患儿共603例,其中男369例,女234例,年龄2～48个月；其中心肌损害共36例。轮状病毒感染患儿中,54．6%有血清CK-MB升高,伴有心肌损害的患儿为3．3%。心肌损害组与无心肌损害组比较,无心肌损害组CK-MB约在病程7 d达高峰,约14 d降至正常；心肌损害组CK-MB在病程14 d左右达高峰,持续约8周左右。在无心肌损害的患儿中,常规治疗组和营养心肌治疗组患者在病程1～14 d的血清CK-MB比较差异无统计学意义（P均＞0．05）；受试者操作特征曲线分析结果显示CK-MB/CK预测心肌损害曲线下面积为0．697（0．611,0．784,95%CI）。结论 CK-MB在小儿轮状病毒感染过程中有其固有的变化规律,对于心肌损害的诊断价值有限。Objective To investagate the change of creatine kinase MB isoenzymes （ CK-MB ） in children with rotavirus diarrhea and to explore the value of CK-MB/CK in the diagnosis of myocardial damage. Methods A retrospective analysis of the clinical manifestation, laboratory test data and treatment was per-formed in children with rotavirus diarrhea and high CK-MB hospitalized in department of infectious disease, Si-hong Children Hospital. We investigated the dynamic changes of CK-MB in the rotavirus diarrhea patients with and without myocardial damage. Within the non-myocardial damage group, the fluctuation of CK-MB was compared between patients with nutrition therapy and patients with conventional therapy. Receiver operating characteristic （ ROC） curve was used to explore the predictive value of CK-MB/CK for the myocardial dam-age. Results A total of 603 patients （369 males, 234 females, aged 2～48 months） with high CK-MB were enrolled in this study （ 36 cases with myocardial damage ） . There were 54. 6% of enrolled patients showing higher CK-MB and 3. 3% of patients had myocardial damage. The levels of serum CK-MB in non-myocardial damage group reached the peak on day 7 and decreased to normal in 14 days. The levels of serum CK-MB in myocardial damage group reached the peak on day 14 and maintained at fairly high level for 8 weeks and then decreased to normal . Time for CK-MB to achieve peak is different between these two groups. There was no statistical significance in the levels of serum CK-MB on day1 to day 14 between patients with or without myocar-dial protection （ P〉0. 05 ） . The ROC curves were constructed with area under the ROC curves of 0. 697 （0. 611, 0. 784, 95%CI）. Conclusion Intrinsic dynamics of CK-MB existed in patients with rotavirus diar-rhea. The diagnostic value of CK-MB is limited in patients with myocardial damage.

关 键 词：肌酸激酶同工酶 轮状病毒感染 动态变化 心肌损害 

分 类 号：R725.1[医药卫生—儿科]