二维斑点追踪技术联合血清心肌损伤标志物检测对病毒性心肌炎患儿预后的预测价值  

Predictive value of two-dimensional speckle tracking imaging combined with serum myocardial injury markers for the prognosis of children with viral myocarditis

作　　者：李卡娜 陈钧 马亦飞 LI Kana;CHEN Jun;MA Yifei(Zhuji People's Hospital of Zhejiang Province,Zhuji,Zhejiang 311800,China)

机构地区：[1]浙江省诸暨市人民医院超声科,浙江诸暨311800 [2]浙江省诸暨市人民医院检验科,浙江诸暨311800

出　　处：《中华医院感染学杂志》2025年第4期587-592,共6页Chinese Journal of Nosocomiology

基　　金：浙江省自然科学基金资助项目(202003N4037)。

摘　　要：目的 分析二维斑点追踪技术(2D-STI)联合血清心肌损伤标志物检测对病毒性心肌炎(VMC)患儿预后的预测价值,为疾病早期确诊提供参考。方法 选取浙江省诸暨市人民医院2020年1月-2023年7月128例VMC患儿,按照病情程度分为轻度组39例、中度组49例、重度组40例,均接受2D-STI检查与血清心肌损伤标志物[心肌肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)以及肌红蛋白(Myo)]检测,比较不同病情组2D-STI检查参数、心肌损伤标志物,按照出院后半年随访预后情况分为良好组与不良组,比较两组临床资料,分析2D-STI联合血清心肌损伤标志物对不良预后的预测效能。结果 重度组后壁-收缩期峰值应变率(SRs)、下壁-收缩期峰值应变(S)、cTnT、CK-MB、Myo分别为(-1.01±0.15) s-1、(-10.38±-1.75)%、(28.90±4.76) ng/L、(15.98±2.94) U/L、(125.79±20.38)μg/L,高于中度组(P<0.05),且中度组高于轻度组(P<0.05);重度组后壁-舒张早期峰值应变率(Esr)、侧壁-Esr分别为(1.57±0.28)s-1、(1.82±0.35) s-1低于中度组(P<0.05),且中度组低于轻度组(P<0.05);后壁-SRs、下壁-S、cTnT、CK-MB、Myo与VMC患儿病情程度呈正相关(P<0.05),后壁-Esr、侧壁-Esr与病情程度呈负相关(P<0.05);不良组后壁-SRs、下壁-S、cTnT高于良好组(P<0.05),后壁-Esr、侧壁-Esr低于良好组(P<0.05);后壁-SRs、后壁-Esr、下壁-S、侧壁-Esr、cTnT及联合预测曲线下面积(AUC)依次为0.780、0.757、0.692、0.854、0.819和0.972,联合预测AUC最大。结论 2D-STI参数、血清cTnT、CK-MB、Myo与VMC患儿病情密切相关,2D-STI参数(后壁-SRs、后壁-Esr、下壁-S、侧壁-Esr)、血清cTnT联合预测不良预后效能较高。OBJECTIVE To analyze the predictive value of two-dimensional speckle tracking imaging(2D-STI)com-bined with serum myocardial injury markers for the prognosis of children with viral myocarditis(VMC),so as to provide reference for early diagnosis of the disease.METHODS Totally 128 children with VMC who were admitted to Zhuji People's Hospital of Zhejiang Province from Jan.2020 to Jul.2023 were selected and divided into 39 cases in the mild group,49 cases in the moderate group and 40 cases in the severe group according to the severity of dis-eases,and all of them underwent 2D-STI examination and detection of serum myocardial injury markers[cardiac troponin T(cTnT),creatine kinase isoenzyme(CK-MB)and myoglobin(Myo)].2D-STI parameters and myo-cardial injury markers were compared among children with different severity.According to the prognosis during 6 months of follow-up after discharge,children enrolled were divided into good group and poor group.Clinical data of the two groups were compared,and the predictive efficacy of 2D-STI combined with serum myocardial injury markers for poor prognosis was analyzed.RESULTS Posterior wall systolic peak strain rate(SRs),inferior wall systolic peak strain(S)and the levels of cTnT,CK-MB and Myo in the severe group were(-1.01±0.15)s^(-1),(-10.38±1.75)%,(28.90±4.76)ng/L,(15.98±2.94)U/Land(125.79±20.38)μg/L,higher than those in the moderate group(P<0.05).Moreover,above parameters in the moderate group were higher than those in the mild group(P<0.05).Posterior wall early diastolic peak strain rate(Esr)and lateral wall Esr increased in the severe group were(1.57±0.28)s^(-1) and(1.82±0.35)s^(-1),lower than those in the moderate group(P<0.05).Meanwhile,the two parameters in the moderate group were lower than those in the mild group(P<O.05).Posterior wall SRs,inferior wall S,cTnT,CK-MB,and Myo were positively correlated with the severity of VMC in children(P<0.05),while posterior wall Esr and lateral wall Esr were negatively correlated with the severity of VMC(P<0.05).Posterior w

关 键 词：病毒性心肌炎 患儿 二维斑点追踪技术 心肌损伤 预后 预测价值 

分 类 号：R542.21[医药卫生—心血管疾病]