肠道病毒71型感染患儿心肌损害及心肌酶谱变化分析

目的探讨肌酸激酶同工酶（CK—MB）／肌酸激酶（CK）在肠道病毒71型（EV71）感染病程中对患儿心肌损害的诊断价值。方法选取2010--2014年EV71感染患儿998例，其中CK-MB／CK〉5％的患儿共477例，根据是否存在心肌损害分为心肌损害组（35例）和非心肌损害组（442例），非心肌损害组按治疗方法分为营养心肌组（209例）和常规治疗组（233例）。在接受常规治疗的基础上，心肌损害组联合营养心肌治疗及其他对症治疗，营养心肌组联合营养心肌治疗。比较各组患儿CK—MB动态变化规律，采用ROC曲线分析CK—MB／CK对心肌损害的预测价值。结果998例EV71感染患儿中约47．8％（477例）伴有CK-MB／CK异常，3．5％（35例）伴有心肌损害。非心肌损害组患儿CK．MB通常在发病的第2-3天达到高峰，持续1～2d，1周左右下降至正常水平；心肌损害组患儿CK—MB高峰则出现在病程的第6～8天，持续4周才缓慢下降至正常水平。营养心肌组和常规治疗组平均治疗时间及病程第7天CK-MB水平比较差异无统计学意义（t=1．767，1．373，P〉0．05）。ROC曲线分析显示CK—MB／CK预测心肌损害曲线下面积为0．638（95％CI：0．554-0．723），以CK—MB／CK=5．0％为界值，其预测心肌损害的灵敏度为76．5％，特异性为53．2％。结论CK—MB在EV71感染病程中可能存在固有的变化规律，CK-MB／CK对于心肌损害诊断价值不高。

Relationship of myocardial enzymology with myocardial damage in children with enterovirus 71 infection

Objective To explore the diagnostic value of creatine kinase isoenzyme （CK-MB）/creatine kinase（CK） ratio for myocardial damage in children with enterovirus 71（EV71 ） infection. Methods Nine hundred and ninety eight patients with EV71 infection from 2010 to 2014 were enrolled in this study. Patients with CK-MB/ CK ratio 〉5% （n=477） were divided into myocardial damage group（n=35） and non-myocardial damage group （n= 442）. Routine treatment was given to all patients, and myocardial nutrition therapy was additionally given to all patients in myocardial damage group and 209 patients in non-myocardial damage group. The dynamic variation of CK-MB was investigated. The predictive value of CK-MB/CK for diagnosing myocardial damage was analysis by ROC. Results Of 998 patients with EV71 infection, 47.8%（477 patients） had higher CK-MB/CK ratio and 3.51% （35 cases） had myocardial damage. The levels of serum CK-MB in non-myocardial damage group reached the peak on day 2 to day 3 and maintained at a fairly high level for 1-2 d and then decreased to noimal in a week. The levels of serum CK-MB in myocardial damage group reached the peak on day 6 to day 8 and decreased to normal in 4 weeks. No significant differences in hospital stay and the levels of serum CK-MB on day 7 were found between patients received additional myocardial nutrition therapy whether or not （t=1.767,1.373, P〉0.05）. ROC analysis showed that the area under the curve for CK-MB/CK predicting myocardial damage was 0.638 （95% CI：0.554- 0.723）. The sensitivity of CK-MB/CK for early prediction of myocardial damage was 76.5% and the specificity was 53.2% when cut-off point was 5%. Conclusions The levels of serum CK-MB in children with EV 71 infection may fluctuate following a pattern, which contributes little value to the diagnosis of myocardial damage.