肌钙蛋白T、抗心肌抗体联合心肌酶检测在小儿暴发性心肌炎诊断中的临床意义  

The Clinical Significance of Troponin T,Anti-Myocardial Antibody and Myocardial Enzyme Test in the Diagnosis of Fulminant Myocarditis in Children

作　　者：吴慧辉 WU Huihui(Department of Clinical Laboratory,Kaiping Hospital,Tangshan People’s Hospital Medical Group,Tangshan 063000,China)

机构地区：[1]唐山市人民医院医疗集团开平医院检验科,河北唐山063000

出　　处：《标记免疫分析与临床》2022年第11期1900-1905,共6页Labeled Immunoassays and Clinical Medicine

基　　金：老年病相关生化诊断试剂量值溯源及质量评价研究(编号:2019YFF0216502)。

摘　　要：目的探讨肌钙蛋白T、抗心肌抗体联合心肌酶检测在小儿暴发性心肌炎诊断中的临床意义。方法回顾性分析本院2019年1月至2021年10月于本院就诊的92例心肌炎患儿的临床资料,其中暴发性心肌炎43例,非暴发性心肌炎49例,另选取同期健康体检患儿40例作为对照组。对比3组受试儿童血清肌钙蛋白T(troponin T,cTnT)、抗心肌抗体(anti-myocardial antibody,AHA)、及心肌酶[肌酸激酶(creatine kinase,CK)、乳酸脱氢酶(lactate dehydrogenase,LDH)、门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)、a-羟丁酸脱氢酶(A-hydroxybutyrate dehydrogenase,a-HBD)]水平。应用受试者工作曲线(receiver operating curve,ROC)分析上述血清指标对小儿暴发性心肌炎的诊断价值。结果同对照组对比,暴发性心肌炎与非暴发性心肌炎患者的血清cTnT、心肌酶表达水平及AHA阳性检出率均更高;与非暴发性心肌炎患者对比,暴发性心肌炎患者上述血清指标水平及AHA阳性检出率均更高(P<0.05)。血清cTnT、AHA、心肌酶联合对暴发性心肌炎诊断的灵敏度、特异性、曲线下面积(AUC)分别为97.37%、83.67%、0.899。联合诊断的灵敏度高于单独预测(χ^(2)=10.965,P=0.001;χ^(2)=7.242,P=0.007;χ^(2)=9.685,P=0.002),特异性与单独预测对比差异均无统计学意义(χ^(2)=0.333,P=0.564;χ^(2)=0.000,P=1.000;χ^(2)=0.079,P=0.779),AUC高于单独预测(Z=2.215,P=0.027;Z=1.908,P=0.047;Z=2.293,P=0.022)。结论血清cTnT、AHA及心肌酶在小儿暴发性心肌炎患者中血清水平升高,上述指标均对暴发性心肌炎有一定诊断价值,且联合诊断价值更高。Objective To investigate the clinical significance of troponin T,anti-myocardial antibody combined with myocardial enzyme test in the diagnosis of fulminant myocarditis in children.Methods The clinical data of 92 children with myocarditis who visited our hospital from January,2019 to October,2021 were retrospectively analyzed,including 43 cases of fulminant myocarditis and 49 cases of non-fulminant myocarditis.Another 40 healthy children who underwent physical examination during the same period were selected as the control group.Serum troponin T(cTnT),anti-myocardial antibody(AHA)and myocardial enzyme creatine kinase(creatine kinase),as well as CK,lactate dehydrogenase(LDH),aspartate aminotransferase(AST),creatine kinase isoenzyme,(Ck-mb)and A-hydroxybutyrate dehydrogenase(A-HBD)were compared among these three groups..Receiver operating curve(ROC)was drawn to analyze the diagnostic value of the above serum indexes for fulminant myocarditis in children.Results Compared with the control group,levels of serum cTnT,myocardial enzyme expression and positive detection rate of AHA were higher in fulminant myocarditis patients and non-fulminant myocarditis patients.Compared with patients with non-fulminant myocarditis,levels of above serum indicators and the positive detection rate of AHA in patients with fulminant myocarditis were higher(P<0.05).The sensitivity,specificity and area under the curve(AUC)of serum cTnT,AHA and myocardial enzyme in the combined diagnosis of fulminant myocarditis were 97.37%,83.67%and 0.899,respectively.The sensitivity of combined diagnosis was higher than that of single prediction(χ^(2)=10.965,P=0.001;χ^(2)=7.242,P=0.007;χ^(2)=9.685,P=0.002),and there was no significant difference between the specificity and single prediction(χ^(2)=0.333,P=0.564;χ^(2)=0.000,P=1.000;χ^(2)=0.079,P=0.779),AUC was higher than that predicted by single test(Z=2.215,P=0.027;Z=1.908,P=0.047;Z=2.293,P=0.022).Conclusion Serum levels of cTnT,AHA and myocardial enzymes are increased in children with fulminant myoc

关 键 词：肌钙蛋白T 抗心肌抗体 心肌酶 小儿 暴发性心肌炎 诊断 

分 类 号：R725.4[医药卫生—儿科]