超声心动图和心肌酶学检测在患儿川崎病合并冠状动脉病变诊断中的应用  

Application value analysis of echocardiography and myocardial enzyme indexes in children with Kawasaki disease complicated with coronary artery disease

作　　者：杨荣荣 马佳娜 YANG Rongrong;MA Jiana(Department of Laboratory,Shangluo Central Hospital,Shaanxi Province,Shangluo 726000)

机构地区：[1]陕西省商洛市中心医院检验科,商洛726000 [2]陕西省商洛市中心医院超声医学科,商洛726000

出　　处：《陕西医学杂志》2020年第10期1259-1261,1265,共4页Shaanxi Medical Journal

基　　金：陕西省自然科学基础研究计划项目(2014JM4131)。

摘　　要：目的:探讨超声心动图和心肌酶学指标在川崎病(KD)合并冠状动脉病变小儿中的诊断应用。方法:纳入KD患儿70例,将合并冠脉病变的患儿纳入A组,未合并冠脉病变的患儿纳入B组。同时纳入同期入院体检的健康儿童60例作为对照组。对三组均进行心肌酶学指标和超声心动图检查。对三组的超声心动图表现进行分析,比较三组左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)以及舒张早期峰值速度与舒张晚期的比值(Em/Am)。比较三组肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)和肌酸激酶(CK)的水平。比较三组不同冠状动脉病变严重程度患者心肌酶水平的变化。结果:A组32例患儿中,30例(93.75%)患儿发生冠脉动脉扩张,其中单纯冠状动脉扩张22例(68.75%),合并内膜增厚4例(12.50%),合并心包积液4例(12.50%),合并二尖瓣反流2例(6.25%)。A组LVEF、Em/A m明显低于B组和对照组(P<0.05),LVEDD水平明显高于B组和对照组(P<0.05)。A组CK-MB、LDH和CK水平均明显高于B组和对照组(P<0.05)。B组和对照组CK-MB、LDH和CK水平比较,差异无统计学意义(P>0.05)。不同冠状动脉病变严重程度患儿中,CK-MB水平间比较差异有统计学意义(P<0.05),LDH和CK水平比较,差异无统计学意义(P>0.05)。结论:超声心动图和心肌酶学指标均为小儿川崎病合并冠状动脉病变的敏感指标,其中超声心动图能够对患儿的冠状动脉血管扩张情况进行清晰展示,CK-MB在不同冠状动脉病变严重程度的评价中具有更好的敏感性。Objective:To analyze the application value of echocardiography and myocardial enzyme indexes in children with Kawasaki disease(KD)and coronary artery disease.Methods:A total of 70 children with KD were included,and those with coronary artery disease were included in group A,and those without coronary artery disease were included in group B.60 healthy children during the same period were included as control group.Myocardial enzyme indexes and echocardiography were performed in all three groups.The echocardiographic performance of the three groups was analyzed,and the LVEF,LVEDD,and Em/Am of the three groups were compared.The levels of CK-MB,LDH and CK among the three groups were compared.Results:In group A,30 cases(93.75%)had coronary artery dilatation,including 22 cases(68.75%)with simple coronary artery dilatation,4 cases(12.50%)with intimal thickening,4 cases(12.50%)with pericardial effusion and 2 cases(6.25%)with mitral regurgitation.The LVEF and Em/Am of group A were significantly lower than those of group B and control group(P<0.05),and the level of LVEDD was significantly higher than that of group B and control group(P<0.05).The levels of CK-MB,LDH and CK in group A were significantly higher than those in group B and control group(P<0.05).There was no significant difference in the levels of CK-MB,LDH and CK between group B and control group(P>0.05).Conclusion:Echocardiography and myocardial enzyme indexes are sensitive indicators of pediatric Kawasaki disease with coronary artery disease.Among them,echocardiography can clearly show the coronary artery vasodilation in children,and CK-MB has better sensitivity in evaluating the severity of coronary artery disease.

关 键 词：超声心动图 心肌酶 小儿 川崎病 冠状动脉病变 诊断 

分 类 号：R725.4[医药卫生—儿科]