危重症患儿胰岛素抵抗与心肌损害的临床相关性研究

目的：危重症患儿多伴明显的胰岛素抵抗和心肌损害。本研究探讨危重症患儿胰岛素抵抗与心肌损害的关系。方法：选取2010年3月至2011年6月住院治疗的危重症患儿63例为病例组,测定空腹血糖、血清胰岛素及心肌酶、肌钙蛋白I（CTnI）水平,同时计算胰岛素抵抗指数（HOMA-IR）。HOMA-IR>1.0 者归入胰岛素抵抗组（30例）,HOMA-IR≤1.0者归入非胰岛素抵抗组（33例）。同时选取健康儿童30例作为对照组。结果：胰岛素抵抗组患儿的HOMA-IR、乳酸脱氢酶（LDH）、天门冬氨酸氨基转移酶（AST）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、α-羟丁酸脱氢酶（α-HBDH）、CTnI水平均明显高于非胰岛素抵抗组及对照组,差异有统计学意义（均P<0.05）;非胰岛素抵抗组患儿的LDH、AST、CK、CK-MB、α-HBDH、CTnI水平明显高于对照组,差异有统计学意义（均P<0.05）。胰岛素抵抗组患儿的HOMA-IR与LDH、CK、CK-MB、AST、α-HBDH、CTnI水平呈正相关（分别r=0.697,0.739,0.781,0.642,0.381,0.792,均P<0.05）。结论：胰岛素抵抗可以加重心肌损害,HOMA-IR可以作为心肌损害程度的预测指标。     

心肌肌钙蛋白I对新生儿窒息心肌损害的早期诊断价值

目的评价心肌肌钙蛋白I（cTn I）对新生儿窒息心肌损害（MCI）的早期诊断价值。方法采用双抗夹心免疫测定方法检测51例生后窒息并MCI新生儿（MCI组）血清cTnI和CK．MB水平，并以57例窒息无MCI（NMCI组）及45例正常新生儿（NC组）作为对照组。结果NC组cTnI水平在生后7d内无变化，MCI组生后24h内和1周时cTnI水平均显著高于NMCI组和NC组（P〈0．01）。MCI组生后24h内CK—MB水平显著高于NMCI组和NC组（P〈0．01）；生后5—7d3组CK—MB水平差异无显著性（P〉0．05），且均明显低于生后24h内水平。cTnI诊断新生儿MCI的敏感度为91％，特异度为88％，准确度89％；CK—MB的敏感度为86．3％，特异度为69％，准确度为74％。结论血清cTnI及CK-MB均可用于新生儿窒息MCI的早期诊断，cTnI优于CK-MB。     

1,6-二磷酸果糖治疗新生儿窒息并心肌损害

目的探讨1,6-二磷酸果糖治疗新生儿窒息后心肌损害的效果。方法新生儿窒息并血清心肌酶谱变化85例患儿,随机分为治疗组45例和对照组40例;二组患儿均采用综合治疗。治疗组予1,6-二磷酸果糖0.10~0.25g/(kg.次),2次/d,快速静脉滴注(10min内滴完),疗程7~10d,入院12h内及治疗后查血清心肌酶谱。结果治疗与对照组治疗后肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、α-羟丁酸脱氢酶(HBDH)比较差异均具有显著性意义(Pa<0.05)。结论1,6-二磷酸果糖对新生儿窒息心肌损害有一定预防及治疗作用。     

心肌酶测定在窒息新生儿心肌损害32例中的应用价值

目的通过对32例窒息后心肌受累的新生儿治疗前后心肌酶谱测定，了解心肌酶谱在窒息新生儿心肌损害诊治中的意义。方法32例均自入院后12h及治疗后5～7天各静脉采血1次，作GOT、LDH、CK、CK-MB检查。结果窒息后心肌损害治疗前后心肌酶谱各项指标比较差异均有显著统计学意义（P〈0．01），出院时心肌酶多恢复正常。结论对窒息新生儿做心肌酶谱检查，有利于早期发现心肌损害并及时治疗，并可作为判断疗效及预后的指标。     

血清心肌肌钙蛋白I诊断川崎病急性期心肌损伤的临床价值

为探讨血清心肌肌钙蛋白I(cTnI)诊断川崎病(KD)急性期心肌损伤的临床价值。检测KD组(n=40)及对照组(n=23)患儿血清cTnI、肌酸激酶(CK)、肌酸激酶同功酶(CK-MB)、乳酸脱氢酶(LDH)与谷草转氨酶(GOT)浓度。结果显示①KD组与对照组血清CK、LDH、GOT浓度无显著性差别(P＞0.05);而血清cTnI、CK-MB浓度明显高于对照组水平(P＜0.001)。②在诊断KD患儿急性期心肌损伤上cTnI优于CK-MB(P＜0.05),。结果表明cTnI与CK-MB对KD患儿急性期心肌损伤有诊断价值;与CK-MB比较,cTnI具有高特异性、灵敏度。     

先天性心脏病心肌损害临床分析

目的 探讨先天性心脏病(先心病)患儿心肌损害程度与缺氧及心功能的关系,为心肌保护提供理论依据。方法 测定115例先心病患儿心肌酶谱和58例先心病心肌肌钙蛋白I(CTnI)。结果 115例中A、D、E组心肌酶谱改变以乳酸脱氢酶(LDH)、乳酸脱氢酶同工酶1(LDH1)、肌酸激酶同工酶(CK-MB)、α-羟丁酸脱氢酶(α-HBDH)增高明显,在各组心肌酶谱结果比较及与正常值比较中,两组有显著差异或非常显著差异(P<0.05或P<0.01);CK-MB／CK>0.05。先心病患儿58例中A、D、E组cTnI检出阳性率明显升高(P<0.05),且A、D、E组中cTnI与LDH、LDH1、CK、α-HBDH阳性率比较,各组间有显著差异(P<0.05),与CK-MB比较,无显著差异(P>0.05)。结论 LDH、LDH1、CK-MB、CK-MB／CK、α-HBDH、cTnI是判断先心病患儿心肌损害重要指标;CK-MB与cTnI是诊断心肌损害的血清金标准。     

血清心肌肌钙蛋白Ⅰ诊断川崎病急性期心肌损伤的临床价值

为探讨血清心肌肌钙蛋白Ⅰ(cTnI)诊断川崎病(KD)急性期心肌损伤的临床价值。检测KD组(n=40)及对照组(n=23)患儿血清cTnI、肌酸激酶(CK)、肌酸激酶同功酶(CK-MB)、乳酸脱氢酶(LDH)与谷草转氨酶(GOT)浓度。结果显示:①KD组与对照组血清CK、LDH、GOT浓度无显著性差别(P>0.05);而血清cTnI,CK-MB浓度明显高于对照组水平(P<0.001)。②在诊断KD患儿急性期心肌损伤上cTnI优于CK-MB(P<0.05),。结果表明:cTnI与CK-MB对KD患儿急性期心肌损伤有诊断价值;与CK-MB比较,cTnI具有高特异性、灵敏度。     

婴幼儿围体外循环期心肌酶学变化及其意义

目的 探讨婴幼儿围体外循环期心肌酶学变化及其意义。方法 51例先天性心脏病患儿，分别于术前（T1）、停外外循环（T2）、体外循环后20nin（T3）、术后6h（T4）、术后24h（T5）采基桡动脉血测定天冬氨酸转移酶（AST）、肌酸激酶（CK）、肌酸激酶同工酶（CK－MB）、乳酸脱氢酶（LDH）、α－羟丁酸脱氢酶（HBDH）活性。结果 与基础值相比，AST、CK、CK－MB、HBDH体外循环后显著升高，LDH术后6h显著升高（P＜0．05）；AST、CK术后6h达峰值，LDH、HBDH术后24h达峰值；CK－MB体外循环的20min达峰值且于术后6h显著下降（与峰值比较P＜0．05）。结论 体外循环有明显的组织损伤作用，心肌酶学可反映组织损伤的程度及变化。     

心肌肌钙蛋白Ⅰ对新生儿窒息心肌损害的早期诊断价值

目的 评价心肌肌钙蛋白Ⅰ(cTn Ⅰ)对新生儿窒息心肌损害(MCI)的早期诊断价值.方法 采用双抗夹心免疫测定方法检测51例生后窒息并MCI新生儿(MCI组)血清cTn Ⅰ和CK-MB水平,并以57例窒息无MCI(NMCI组)及45例正常新生儿(NC组)作为对照组.结果 NC组cTn Ⅰ水平在生后7 d内无变化,MCI组生后24 h内和1周时cTn Ⅰ水平均显著高于NMCI组和NC组(P＜0.01).MCI组生后24 h内CK-MB水平显著高于NMCI组和NC组(P＜0.01);生后5～7 d 3组CK-MB水平差异无显著性(P＞0.05),且均明显低于生后24 h内水平.cTn Ⅰ诊断新生儿MCI的敏感度为91%,特异度为88%,准确度89%;CK-MB的敏感度为86.3%,特异度为69%,准确度为74%.结论 血清cTn Ⅰ及CK-MB均可用于新生儿窒息MCI的早期诊断,cTn Ⅰ优于CK-MB.     

窒息新生儿心肌损害的早期诊断

目的探讨血清肌酸磷酸激酶同工酶(CK-MB)及心肌肌钙蛋白Ⅰ(cTnⅠ)对新生儿(MCI组)窒息心肌损害(MCI)的早期诊断价值。方法采用直接化学发光免疫夹心法和免疫抑制酶动力学法动态检测34例生后10 d内窒息并MCI新生儿(MCI组)血清cTnⅠ和CK-MB水平,并以38例窒息无心肌损害(NMCI组)及30例正常新生儿(NC组)作为对照组。结果NC组cTnⅠ水平在生后10 d内无变化,MCI组生后24 h内和1周时cTnⅠ水平均显著高于NMCI组和NC组(P均<0.01)。MCI组生后24 h内CK-MB水平显著高于NMCI组和NC组(P均<0.01);3组生后5~7 d检测值比较均无统计学差异(P均>0.05),且均明显低于生后24 h内水平。cTnⅠ诊断新生儿MCI的敏感度为91%,特异度为88%,准确度89%;CK-MB诊断新生儿MCI敏感度为85%,特异度为68%,准确度为74%。结论血清CK-MB及cTnⅠ均可用于新生儿窒息心肌损害的早期诊断,cTnⅠ优于CK-MB。     

轻度窒息新生儿动态心电图及心肌酶变化的临床研究

目的 探讨轻度窒息新生儿动态心电图（AECG）、心肌酶变化特点及其临床意义.方法 选取2011年6月至2013年8月我院新生儿科收治的轻度窒息新生儿为窒息组,同期选择本院分娩的30例健康新生儿为对照组,均于生后24h内行AECG检查,于出生18 ～24 h内抽取静脉血测定血清肌酸磷酸激酶（CK）、血清肌酸磷酸激酶同工酶（CK-MB）、血清乳酸脱氢酶（LDH）、血清谷草转氨酶（AST）、心肌肌钙蛋白（cTnI）.结果 窒息组（46例）与对照组（30例）新生儿AECG窦性心律指标（最慢心率、最快心率、平均心率）差异均无统计学意义（P＞0.05）;窒息组ST段改变及心律失常等其他几项综合指标（包括房早、房速、室早、Q-T间期延长、交界性逸搏）异常发生率高于对照组（65.2％比16.7％,89.1％比13.3％,P均＜0.01）.窒息组心肌酶指标及cTnI值均高于对照组[CK（604.7±275.4）比（162.0±95.1）,CK-MB（87.9±61.0）比（28.3±27.1）,LDH（686.0±383.5）比（310.7±133.5）,AST （95.0±63.1）比（35.2±13.9）,cTnI（0.12±0.11）比（0.02±0.01）,P均＜0.01].窒息组CK、CK-MB、LDH、AST异常发生率高于对照组（63.0％比16.7％,82.6％比6.7％,95.7％比20.0％,32.6％比6.7％,P均＜0.01）.结论 轻度窒息新生儿AECG监测可发现各种心律失常、ST段改变,其心肌酶亦明显高于正常新生儿,ST段改变及CK-MB的升高是诊断轻度窒息新生儿心肌损伤的可靠依据.     

Troponin-T levels in perinatally asphyxiated infants during the first 15 days of life

Aim: To measure serial cardiac troponin‐T, creatine kinase, creatine kinase‐MB, aspartate aminotransferase, alanine aminotransferase and lactate dehydrogenase levels in asphyxiated newborn infants during the first 15 d of life. Methods: Troponin‐T, creatine kinase, creatine kinase‐MB, aspartate aminotransferase, alanine aminotransferase and lactate dehydrogenase (LDH) concentrations were measured prospectively in blood samples obtained from 45 asphyxiated and 15 healthy term neonates within the first 2–4 h, third, seventh and 15th days. Results: Infants with severe asphyxia had significantly higher cardiac troponin‐T levels than grade I and II asphyxiated and healthy neonates within the first 2–4 h of life (0.34 ± 0.21 ag/ml vs 0.07 ± 0.03 ag/ml, 0.12 ± 0.07 ag/ml, 0.04 ± 0.02 ag/ml, respectively). Troponin‐T levels remained high on days 3 and 7 in severely asphyxiated neonates. The creatinine kinase‐MB levels were significantly higher in grade II and III asphyxiated neonates than grade I asphyxiated and healthy neonates within the first 2–4 h. No difference was found in creatinine kinase‐MB on day 3. There was cardiac involvement in 12 (80%) newborns of group III on B mode echocardiographic images on day 1. However, no echocardigraphic pathology was found in the seventh‐ and 15th‐day echocardiographic analysis in any groups. Conclusion: Our results suggest that asphyxia‐related cardiac changes were significant but reversible in severely asphyxiated neonates, and troponin T is a good determinant of the degree of injury to the heart within the first week of life. Cardiac troponin T also has a wider diagnostic frame than other diagnostic markers of myocardial damage.     

窒息新生儿肾功能损害尿NAG和RBP的变化

目的：探讨窒息新生儿肾功能损害尿N-乙酰-β-D氨基葡萄糖苷酶(NAG),尿视黄醇结合蛋白(RBP)的变化。方法：采用对硝基苯酚比色法及ELISA测定窒息足月儿、早产儿和正常足月儿、早产儿生后第1,3,7天尿NAG活性和尿RBP含量。结果：重度窒息足月儿、早产儿生后第3,7天尿NAG水平均明显高于对照组(P0.05)。结论：尿NAG,RBP可作为早期监测肾功能损害的常规方法,尿RBP是一项较尿NAG更敏感的肾功能损害的早期诊断指标。     

Myocardial ischaemia in neonates with perinatal asphyxia

In asphyxiated neonates, hypoxia is often responsible for myocardial ischaemia. To evaluate cardiac involvement in neonates with respiratory distress, ECG and echocardiographic recordings were performed, and cardiac enzymes determined. These data were related to clinical presentation and patient outcome. Three groups of neonates were studied: 22 healthy newborn infants (group I) with 5 min Apgar scores >9 and pH >7.3; 15 neonates with moderate respiratory distress (group II) which had Apgar scores ranging between 7 and 9, and pH between 7.2 and 7.3; and 13 neonates with severe asphyxia, Apgar scores <7, and pH <7.2 (group III). The ECGs were evaluated according to the 4-grade classification proposed by Jedeikin et al. [8]. On the echocardiograms, fractional shortening and aortic flow curve parameters were taken into account. Serum creatine kinase (CK), creatine kinase-MB isoenzyme (CK-MB) and lactate dehydrogenase were determined. All of groups I and II survived, but 5 out of 13 in group III died within the 1st week. Grade 3 or 4 ECG changes were observed only in group III patients, while all group II and 3 patients of group I showed grade 2 ECG changes. Fractional shortening, peak aortic velocity and mean acceleration were significantly reduced in group III, whereas the only abnormality found in group II was a reduced fractional shortening. CK, CK-MB, CK-MB/CK ratio and lactate dehydrogenase were all increased in group III, while in group II only CK-MB and the CK-MB/CK ratio were abnormal. Conclusion Severely asphyxiated newborn infants reflect relevant ischaemic electro- cardiographic changes, depressed left ventricular function and marked cardiac enzyme increase. These alterations are far less pronounced in neonates with mild respiratory distress. Received 5 May 1998 / Accepted in revised form: 11 January 1999     

Myocardial Ischaemia in Aphyxia Neonatorum

ABSTRACT. Serial electrocardiograms and creatine kinase (CK) isoenzyme activities were studied prospectively in 20 asphyxiated term newborn infants and 43 normal neonates. By adapting a previously described grading system for ischaemic changes, a degree of electrocardiographic ischaemia was defined which occurred almost solely in asphyxiated infants. Infants with this degree of abnormality had signficantly higher mean CK-MB and MM activities than other asphyxiated infants at 0, 8 and 28 hours. Histological changes of peripartum myocardial necrosis were seen in 4 of the 5 infants on whom an autopsy was performed, and either electrocardiogram or CK-MB was abnormal in all four. It is concluded that myocardial injury in the newborn period is often associated with CK-MB release, but in view of the lack of cardiac-specificity of CK-MB in newborn infants, caution is urged in the interpretation of elevated isoenzyme activity in the neonate.     

肌钙蛋白Ⅰ在新生儿胎粪吸入综合征并心肌损伤诊断中的意义

目的　探讨心肌肌钙蛋白Ⅰ (CTn Ⅰ )在新生儿胎粪吸入综合征 (MAS)并心肌损伤诊断中的意义。方法　用化学发光免疫法及酶法分别测定 35例合并心肌损伤的MAS患儿、30例无心肌损伤的MAS患儿及 15例正常对照组血清CTn Ⅰ及CK MB的水平。结果　心肌损伤组生后 2～ 3dCTn Ⅰ浓度为 (0 .6 7± 0 .13)ng/ml,较MAS对照组 [(0 .0 7± 0 .0 5 )ng/ml]和正常对照组 [(0 .0 7± 0 .0 3)ng/ml]明显升高 ,差异有显著性意义 (P <0 .0 5 )。结论　CTn Ⅰ是诊断新生儿MAS并心肌损伤的特异性指标之一。     

血清肌酸磷酸激酶同工酶及心肌肌钙蛋白早期诊断窒息新生儿心肌损害

目的　探讨血清肌酸磷酸激酶同工酶 (CK- MB)及心肌肌钙蛋白I(cTnI)测定对窒息新生儿心肌损害的早期诊断价值。方法　窒息组 40例 (轻度窒息、重度窒息各 2 0例 )、对照组 2 0例 ,生后 1、5、1 0d测定血清CK MB及cTnI水平。结果　窒息组生后 1d血清CK- MB及cTnI明显高于对照组 (P均 <0 .0 1 ) ,重度窒息组明显均高于轻度窒息组 (P均 <0 .0 1 ) ,治疗后呈逐渐下降趋势。血清CK- MB及cTnI对心肌损害诊断的敏感性无显著差异 (P >0 .0 5)。结论　血清CK MB及cTnI可用于窒息新生儿心肌损害的早期诊断。     

Comparison of serum cardiac troponin T and creatine kinase MB isoenzyme mass concentrations in asphyxiated term infants during the first 48 h of life

OBJECTIVE: This prospective study aimed to compare serum creatine kinase MB isoenzyme (CK-MB) mass concentrations and cardiac troponin T (cTnT) concentrations during the first 48 h of life in asphyxiated term infants. METHODS: Serum cTnT and CK-MB mass concentrations of 50 term infants with clinical features of perinatal asphyxia were measured at birth and at 12, 24 and 48 h of age by chemiluminescence immunoassay. These infants were followed up until discharge or death. Cord blood CK-MB and cTnT concentrations of 50 healthy term infants were also assayed. RESULTS: At birth, asphyxiated infants had significantly higher concentrations of cTnT and CK-MB than controls (P < 0.0001). Serum cTnT of asphyxiated infants with low ejection fraction <60% was significantly higher at 12 and 24 h than those with normal ejection fraction (P < 0.05). Asphyxiated infants with congestive cardiac failure had significantly higher serum cTnT concentration during the first 48 h of life than those without congestive cardiac failure (P or= 0.1). CONCLUSION: Unlike CK-MB, serum cTnT concentrations are significantly higher in asphyxiated infants who die or develop cardiac dysfunction.     

肌钙蛋白Ⅰ在新生儿胎粪吸入综合征并心肌损伤诊断中的意义

目的 探讨心肌肌钙蛋白Ⅰ(CTn-Ⅰ)在新生儿胎粪吸入综合征(MAS)并心肌损伤诊断中的意义。方法：用化学发光免疫法及酶法分别测定35例合并心肌损伤的MAS患儿、30例无心肌损伤的MAS患儿及15例正常对照组血清CTn-Ⅰ及CK-MB的水平。结果：心肌损伤组生后2～3 d CTn-Ⅰ浓度为(0.67±0.13) ng/ml,较MAS对照组［(0.07±0.05) ng/ml］和正常对照组［(0.07±0.03) ng/ml］明显升高,差异有显著性意义(P<0.05)。结论：CTn-Ⅰ是诊断新生儿MAS并心肌损伤的特异性指标之一。