动态心电图联合BNP、CK-MB在急性上呼吸道感染并发病毒性心肌炎诊断中的应用价值  

The value of dynamic electrocardiogram combined with BNP and CK-MB in the diagnosis of acute upper respiratory tract infection complicated with viral myocarditis

作　　者：唐瑜 刘杰 丁鹏[3] 王祥林 Tang Yu;Liu Jie;Ding Peng;Wang Xianglin(Department of Cardiology,Xi'an High-tech Hospital,Xi'an 710075,China;不详)

机构地区：[1]西安高新医院心内科,西安710075 [2]西安高新医院呼吸内科,西安710075 [3]西安医学院第二附属医院心内科,西安710038

出　　处：《中国循证心血管医学杂志》2020年第11期1374-1377,1382,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨动态心电图、脑钠肽(BNP)、肌酸激酶同工酶(CK-MB)在急性上呼吸道感染并发病毒性心肌炎诊断中的应用价值。方法分析2015年12月至2019年12月于西安高新医院收治的1486例急性上呼吸道感染患者,选取其中符合条件的162例为研究对象,所有病例均经临床确诊,其中并发病毒性心肌炎患者94例,未并发病毒性心肌炎患者68例。采用酶速率法测定血清CK-MB水平,免疫荧光测定法测定血清BNP水平,并采用动态心电图和常规心电图检测患者心电图特征。结果动态心电图房性早搏、室性早搏、窦性心动过速、短阵室性心动过速、短阵室性心动过缓、Ⅰ度房室传导阻滞、Ⅱ度房室传导阻滞、QRS低电压、ST段改变、T波改变的检出率高于常规心电图(P<0.05);急性上呼吸道感染并发病毒性心肌炎患者血清BNP、CK-MB水平均高于未并发病毒性心肌炎患者(P<0.05);动态心电图、BNP、CK-MB以及三者联合检测检出急性上呼吸道感染并发病毒性心肌炎与临床病理诊断一致性分别为较高(Kappa值=0.788,P<0.05)、较高(Kappa值=0.742,P<0.05)、较高(Kappa值=0.753,P<0.05)、极高(Kappa值=0.898,P<0.05);与动态心电图、BNP、CK-MB单独检测相比,联合检测敏感度、正确率、阴性预测值增加(P<0.05),漏诊率降低(P<0.05)。结论动态心电图、BNP、CK-MB对急性上呼吸道感染并发病毒性心肌炎均有较好的诊断能力,其中动态心电图的检出率较高、发现病变的能力较好。Objective To investigate the values of dynamic electrocardiogram,B-type natriuretic peptide(BNP),creatine kinase isoenzyme(CK-MB)in the diagnosis of acute upper respiratory tract infection complicated with viral myocarditis.Methods Analysis of 1486 patients with acute upper respiratory tract infection admitted in Department of Cardiology,Xi'an High-tech Hospital from December 2015 to December 2019,and 162 eligible patients were selected as the research object,and all cases were clinically confirmed,including 94 patients with viral myocarditis and 68 patients without viral myocarditis.The level of serum CK-MB was measured by enzyme rate method,the level of serum BNP was measured by immunofluorescence,and the dynamic electrocardiogram and routine electrocardiogram were used to detect the electrocardiogram characteristics of patients.Results For atrial premature beat,ventricular premature beat,sinus tachycardia,short array ventricular tachycardia,short array ventricular bradycardia,Ⅰatrioventricular block,Ⅱatrioventricular block,QRS low voltage,ST segment change,T wave change,the detection rats of dynamic electrocardiogram were higher than those of routine electrocardiogram(P<0.05);the levels of serum BNP and CK-MB in patients with acute upper respiratory tract infection and viral myocarditis were higher than those without viral myocarditis(P<0.05);the results of dynamic electrocardiogram,BNP,CK-MB and their combined detection in acute upper respiratory tract infection complicated with viral myocarditis showed that their consistence with clinicopathological diagnosis was higher(Kappa value=0.788,P<0.05),higher(Kappa value=0.742,P<0.05),higher(Kappa value=0.753,P<0.05),extremely high(Kappa value=0.898,P<0.05);compared with dynamic electrocardiogram,BNP and CK-MB single detection,the sensitivity,accuracy and negative predictive value of combined detection were higher(P<0.05),while the missed diagnosis rate was lower(P<0.05).Conclusions Dynamic electrocardiogram,BNP and CK-MB have better diagnostic ability for acut

关 键 词：急性上呼吸道感染 病毒性心肌炎 动态心电图 B型钠尿肽 肌酸激酶同工酶 

分 类 号：R540.41[医药卫生—心血管疾病]