轮状病毒性肠炎患儿心肌损伤的危险因素及益生菌干预效果研究  

Risk Factors of Myocardial Damage in Children with Rotavirus Enteritis and the Intervention Effect of Probiotics

作　　者：王荣花[1] 李娟利[1] 姜红[2] 史瑞明[1] WANG Ronghua;LI Juanli;JIANG Hong;SHI Ruiming(The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;School of Public Health,Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院,陕西省西安市710061 [2]西安交通大学公共卫生学院,陕西省西安市710061

出　　处：《实用心脑肺血管病杂志》2019年第1期57-61,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：背景轮状病毒性肠炎是儿童常见疾病,心肌损伤是其较常见并发症之一,严重时可诱发心肌炎并影响患儿生存质量,但目前轮状病毒性肠炎患儿心肌损伤的危险因素尚未完全明确,且缺乏有效干预措施。目的分析轮状病毒性肠炎患儿心肌损伤的危险因素,并观察益生菌的干预效果。方法选取2016年1月—2017年1月西安交通大学第一附属医院儿科收治的轮状病毒性肠炎患儿138例,其中有心肌损伤患儿35例(A组),无心肌损伤患儿103例(B组);根据治疗方法将心肌损伤患儿分为对照组(n=12)和干预组(n=23)。在对症治疗基础上,对照组患儿给予肠炎宁治疗,干预组患儿在对照组基础上给予双歧杆菌三联活菌治疗;两组患儿均连续治疗1周。比较A组与B组患儿一般资料、血常规检查结果、血电解质及N末端脑钠肽前体(NT-proBNP),轮状病毒性肠炎患儿心肌损伤的影响因素分析采用多因素Logistic回归分析;比较对照组与干预组患儿治疗前后心肌酶谱及治疗期间不良反应发生情况。结果 (1)A组与B组患儿性别、病程、腹泻次数、有无呕吐、有无重度脱水及中性粒细胞百分比比较,差异无统计学意义(P>0.05);A组与B组患儿年龄、有无发热、有无代谢性酸中毒、白细胞计数(WBC)、血红蛋白、红细胞分布宽度(RDW)、血钠、血钾及NT-proBNP比较,差异有统计学意义(P<0.05)。(2)多因素Logistic回归分析结果显示,年龄<1岁〔OR=3.307,95%CI(1.276,8.580)〕、RDW≥15.4%〔OR=1.133,95%CI(1.002,1.282)〕、血钾<3.5 mmol/L〔OR=3.865,95%CI(1.720,8.684)〕、NT-proBNP≥100 mg/L〔OR=1.114,95%CI(1.007,1.238)〕是病毒性肠炎患儿心肌损伤的危险因素(P<0.05)。(3)对照组与干预组患儿治疗前天冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶(CK)及肌酸激酶同工酶(CK-MB)水平比较,差异无统计学意义(P>0.05);干预组患儿治疗后AST、LDH、CK及CK-MB水平低于对照组(P<0.05Background Rotavirus enteritis is a common disease in children,myocardial damage is one of relatively common complications of rotavirus enteritis,which may induce myocarditis in severe cases and affect the quality of life. However,risk factors of myocardial damage in children with rotavirus enteritis are not very clear and effective interventions are lacking. Objective To analyze the risk factors of myocardial damage in children with viral enteritis,and to analyze the intervention effect of probiotics. Methods A total of 138 children with viral enteritis admitted to the First Affiliated Hospital of Xi'an Jiaotong University from January 2016 to January 2017 were enrolled in the study,and they were divided into A group (complicated with myocardial damage,n=35)and B group(did not complicate with myocardial damage,n=103)according to the incidence of myocardial damage;children in A group were divided into control group(n=12)and intervention group (n=23)according to therapeutic methods. On the basis of symptomatic treatment,children in control group were treated with Changyanning,while children in intervention group were treated with Bifidobacterium triplex viable bacteria on the basis of the control group;both groups continuously treated for one week. General information,blood routine examination results,blood electrolytes and NT-proBNP were compared between A group and B group;influencing factors of myocardial injury in children with rotavirus enteritis were analyzed by multivariate Logistic regression;myocardial enzymes before and after treatment, incidence of adverse reactions during treatment were compared between control group and intervention group. Results (1) There was no statistically significant difference in gender,course of disease,frequency of diarrhea,incidence of vomiting or severe dehydration,or neutrophil percentage between A group and B group(P>0.05);there were statistically significant differences in age,incidence of fever and metabolic acidosis,WBC,hemoglobin,RDW,blood natrium,blood potassium and

关 键 词：肠炎 轮状病毒感染 心肌损伤 危险因素 益生菌 

分 类 号：R516.1[医药卫生—内科学]