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。     

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。     

急性期川崎病儿血清心肌肌钙蛋白Ⅰ变化及临床意义

目的：探讨心肌肌钙蛋白Ⅰ（cTnⅠ）在川崎病（KD）早期心肌损害的诊断价值。方法：应用ELISA法检测40例急性期KD患儿和20例正常对照血清cTnⅠ、肌酸磷酸激酶同工酶（CK－MB）。结果：40例中19例（47．5％）血清cTnⅠ明显升高,10例（25％）血清CK－MB明显升高,8例（20％）血清cTnⅠ和CK－MB均升高。结论：血清cTnⅠ为诊断KD患儿早期发生心肌炎或轻微心肌损伤的特 异性生物学指标,指导早期IVIG治疗,从而防止KD患儿心血管并发症的发生。     

心肌肌钙蛋白T在川崎氏病早期的诊断意义

目的 探索心肌肌钙蛋白Ｔ（ｃＴｎＴ）在川崎氏病早期的意义。方法 应用ＥＬＩＳＡ方法对２５例川崎氏病早期的病人血清中ｃＴｎＴ,ｃＣＰＫ,ＣＫ－ＭＢ进行监测,观察其对心肌缺氧的敏感性,并选择ｃＴｎＴ与心脏扇扫提示的冠状动脉改变情况进行对比。结果２５例中１４例ｃＴｎＴ,１例ＣＰＫ,１例ＣＫ－ＭＢ升高,２１例冠状动脉有改变,冠状动脉无改变４例中２例ｃＴｎＴ升高且同时伴有心电图改变。     

儿童心前区不适病因分析及心肌肌钙蛋白I的诊断价值

目的：儿童心前区不适是较常见的临床主诉,少数是严重心血管疾病的症状,可造成猝死。为了探讨小儿心前区不适的临床特点及病因,该研究检测心肌肌钙蛋白I(cTnI)、ECT心肌灌注显像(MPI)以了解有否存在心肌损害及心肌灌注情况,并比较其相关性。方法：对123例心前区不适的患儿行详细的病史采集,体格检查,摄胸片、检查常规心电图、Holter心电图、超声心动图,测定肌酸激酶同工酶MB(CKMB)、cTnI,部分病例同时进行了MPI检查并按MPI减低程度分4个等级。用等级相关分析cTnI与心肌灌注减低程度的相关性。结果：123例患儿中81例(65.9%)临床诊断为非心源性疾病,cTnI、CKMB均正常;42例(34.1%)诊断为心源性疾病,17例cTnI升高,36例心肌灌注有不同程度的减低。等级相关分析显示cTnI平均值与MPI减低程度呈正相关(r=0.974,P<0.01)。结论：儿童心前区不适大多为非心源性疾病,cTnI可提高诊断的特异性,其平均值与MPI减低程度呈正相关,结合ECT可提高儿童心肌损害的诊断水平。     

心肌肌钙蛋白T在川崎氏病早期的诊断意义

目的　探索心肌肌钙蛋白T(cTnT)在川崎氏病早期的意义。方法　应用ELISA方法对25例川崎氏病早期的病人血清中cTnT、CPK、CKMB进行监测,观察其对心肌缺氧的敏感性,并选择cTnT与心脏扇扫提示的冠状动脉改变情况进行对比。结果　25例中14例cTnT,1例CPK,1例CKMB升高,21例冠状动脉有改变,冠状动脉无改变4例中2例cTnT升高且同时伴有心电图改变。结论　①在川崎氏病早期cTnT的敏感性高于CPK和CKMB;②CTnT可以提示一些扇扫中无法发现的冠状动脉异常所致的心肌缺血     

心肌肌钙蛋白I在儿科心血管疾病中的应用

心肌肌钙蛋白Ｉ（ＣＴｎＩ）为心肌肌钙蛋白（ＣＴｎ）的三个亚单位之一,仅存在于心肌收缩蛋白的细肌丝上,在肌肉收缩和舒张过程中起重要作用。ＣＴｎＩ是心脏特异性抗原,其释放入血循环是心肌细胞损伤的高度敏感和特异性的标志,对某些儿科心血管疾病的诊断及预后有重要意义。     

川崎病冠状动脉病变心肌肌钙蛋白的改变

目的　探讨心肌肌钙蛋白 (cTnI)与川崎病冠状动脉病变的关系。方法　应用化学发光免疫方法检测急性期川崎病 (KD)并冠状动脉病变与KD无冠状动脉病变儿血清cTnI,并与原田计分法进行比较。结果　KD患儿cTnI两组有明显差异。cTnI评价KD冠状动脉病变的敏感性、特异性、阳性预告值分别为 73 % ,76 % ,69% ,与原田计分法比较无显著性差异 (P >0 .0 5)。结论　cTnI是评价KD冠状动脉病变的指标之一。cTnI>0 .3μg/L可作为KD冠状动脉病变的早期预告因子。     

血清心脏肌钙蛋白I对小儿病毒性心肌炎诊断和转归监测价值

目的：评价心脏肌钙蛋白I(cTnI)对小儿病毒性心肌炎的诊断价值,探讨其与肌酸激酶同功酶(CK-MB)以及病毒性心肌炎的病程、病情演变等之间的关系。方法：采用免疫层析法和速率法测定38例病毒性心肌炎和24例非心肌炎患儿血清cTnI,CK-MB。间接ELISA法测定柯萨基病毒B1-6IgM(CVB1-6-IgM)。结果：病毒性心肌炎患儿血清cTnI和CK-MB阳性率分别为 89.5%,60.5%,明显高于非心肌炎组(8.3%,29.2%)和对照组(0)(P<0.05)。82.4% 的血清cTnI阳性出现在病程1周以内。CVB 1-6 IgM阳性与阴性组的cTnI和CK-MB阳性率差异无显著性。结论：血清cTnI反映心肌细胞损害的敏感性和特异性均高于CK-MB,有较宽的诊断时间窗,是一项极具临床价值的心肌炎诊断和转归监测新指标。     

川崎病患儿红细胞补体I活性及IgE变化

本文检测了17例川崎病(KD)患者红细胞补体I(CR-Ⅰ)活性及其调节因子、血清IgE水平,并对上述指标进行探讨和分析.     

Elevation of Cardiac Troponin I in the Acute Stage of Kawasaki Disease

The study was performed to investigate the level of serum cardiac troponin I (cTnI), a marker specific for myocardial damage, using a chemiluminescent immunoassay in the acute febrile stage of Kawasaki disease (KD). The study population consisted of 45 KD patients before intravenous gamma-globulin (IVGG) therapy and a control group of 20 patients without KD. Among KD patients the results from measurements of the level of cTnI were positive in 18 cases (40%) and the creatine kinase (CK)-MB was positive in 11 cases (24%), but in the control group both the cTnI and CK-MB results were negative. Seven KD patients (15.6%) showed increases in both cTnI and CK-MB that were significantly correlated with each other (p < 0.05); however, CK-MB is not heart-specific. A significant increase in the level of cTnI in the acute stage of KD suggests that acute myocarditis or myocardial cell injury begins in the early phase of the disease (p < 0.05). The serologic test for cTnI can thus be a useful method for the early diagnosis of acute myocarditis and may enable early treatment with IVGG to reduce the cardiovascular abnormalities in KD patients.     

川崎病患儿血清脑利钠肽的水平改变及其与肌钙蛋白Ⅰ的对比分析

目的 通过观察川崎病(KD)患儿脑利钠肽(BNP)的水平变化,并与肌钙蛋白Ⅰ(cTrⅠ)比较,探讨其在KD早期诊断中的作用.方法 选择住院KD患儿21例作为研究对象,20例健康体检儿童作为对照组.对KD组及对照组采用酶联免疫吸附法测定血浆BNP、cTnⅠ浓度,并行心脏多普勒超声检查测定冠状动脉内径.结果 KD患儿血浆BNP水平[(517.26±213.40)μg/L]明显高于对照组[(37.55±7.56)μg/L],差异有非常显著性(P＜0.01);cTnⅠ浓度[(0.31±0.17)μg/L]也高于对照组[(0.13±0.04)μg/L],差异有显著性(P＜0.01).KD患儿BNP异常率(100%)明显高于cTnⅠ(47.7%),差异有非常显著性(P＜0.01);冠状动脉病变组血浆BNP、cTnⅠ水平明显高于非冠状动脉病变组;典型KD患儿及不完全型KD患儿BNP及cTnⅠ血浆水平间差异无显著性(P＞0.05).结论 KD患儿血浆BNP、cTnⅠ浓度均明显升高,而BNP具有更高的特异性及灵敏度.血浆BNP水平测定有助于KD的诊断,尤其是不完全型KD早期诊断.     

Circulating Cardiac Troponin I Levels in Kawasaki Disease

In addition to the vascular findings of Kawasaki disease (KD), clinical, electrocardiographic, and/or echocardiographic signs of myocarditis are recognizable in the acute phase of KD in many patients. The mechanism of myocarditis and an association with the development of subsequent coronary artery abnormalities in KD is unknown. Previous studies of serum cardiac troponin I (cTnI) measurements in pediatric populations have suggested a possible utility of measurements in diagnosis and follow-up of KD. We designed a retrospective study to evaluate cTnI measurements during acute KD and to assess the predictive value of cTnI measurements in acute KD for the subsequent development of coronary artery abnormalities. Twenty-nine children were studied. Group 1 consisted of 15 KD patients who developed coronary artery abnormalities as detected by transthoracic echocardiographic evaluation. Group 2 consisted of 14 KD patients with persistently normal coronary artery findings on echocardiograms. A control group consisted of 11 children, none of whom were known to have had clinical findings of KD or myocarditis. The mean cTnI values for all three groups were lower than the values suggestive of cardiac damage: group 1 = 0.11 ± 0.16 ng/ml, group 2 = 0.15 ± 0.34 ng/ml, and control = 0.04 ± 0.08 ng/ml. The current study demonstrates that there is no significant elevation of cTnI in KD patients. Additionally, there is no correlation between cTnI measurements and the finding of myocarditis, as reflected by decreased cardiac function, or the subsequent development of coronary artery abnormalities.     

川崎病患儿抗心磷脂抗体检测的意义

目的：检测川崎病(KD)患儿血清中抗心磷脂抗体(ACA),探讨ACA与KD血管损害的关系。方法：55例急性期KD患儿,采用ELISA方法检测血中ACA-IgG,IgM和IgA三种亚型。结果：55例急性期KD患儿血清ACA-IgG阳性31例,ACA-IgM阳性13例。急性期KD组ACA-IgG,IgM阳性率比对照组显著增高(P<0.01);治疗后ACA-IgG阳性率仍高于对照组(P<0.05),而ACA-IgG阳性或阴性两组的临床表现比较差异均无显著性(P>0.05),但6例伴有血栓形成者有5例ACA-IgG阳性。结论：ACA-IgG是KD常见的抗体,ACA-IgG阳性与KD血栓性血管损害关系密切,但对病情判断无作用。     

扩张型心肌病患儿血清心肌肌钙蛋白测定的意义

目的观察扩张型心肌病(DCM)患儿心功能不全时血清心肌钙蛋白水平变化,并分析其与预后的关系。方法采用酶联免疫吸附法对56例DCM患儿进行血清心肌肌钙蛋白测定。结果心功能Ⅳ级患儿组血清心肌肌钙蛋白水平(0.53±0.31)μg/L明显高于心功能Ⅲ级组(0.45±0.27)μg/L,而心功能Ⅲ级患儿组明显高于心功能Ⅱ级组(0.29±0.27)μg/L,差异具有显著意义。结论血清心肌肌钙蛋白水平随DCM患儿心功能不全发展渐升高,且与心功能不全程度呈正相关,有助于预后判断。     

川崎病临床表现与早期诊断的探讨

目的：探讨建立一种早期诊断川崎病(KD)的诊断指标的可能性。方法：参照KD现行诊断标准,统计分析69例KD患儿各种临床表现出现的时间及发生率。结果：本病早期发热、唇红和或干裂、皮疹、眼结膜充血的发生率分别为100%,92.8%,84%,81%;肛周皮肤潮红和/或脱皮96%出现在起病8 d内,卡介苗接种疤痕(卡疤)反应常在起病3 d内出现。结论：KD患儿发热、皮肤粘膜改变是主要临床表现,当出现发热、唇红干裂、眼结膜充血的“川崎面容”时即应高度怀疑KD的可能。肛周皮损及“卡疤”反应具有早期诊断的价值。     

Intravenous γ-Globulin Treatment in Kawasaki Disease

A multicenter randomized controlled study was carried out to assess the effectiveness of different, doses and kinds of γ-globulin in Kawasaki disease. Gamma globulin lowered the incidence of coronary artery abnormalities. The effect of γ-globulin was dose dependent. The intact type was more effective than the pepsin treated type. To establish the indications for γ-globulin, a study was made of patients who received neither γ-globulin nor indomethacin and who, within nine days of onset of illness, satisfied at least four of the following criteria: (1) WBC: more than 12,000/mm; (2) platelet count: less than 35×10⁴γmm; (3) CRP: more than 3 +; (4) Hct: less than 35%; (5) albumin: less than 3.5 g/dl (6) age: 12 months or less; (7) male sex. This prospective study is continuing. Of 143 children, 73.4% received γ-globulin, and only two demonstrated small dilatations of the coronary arteries in children who did not receive γ-globulin. These guidelines seem satisfactory to establish the indications for γ-globulin in Kawasaki disease.     

心型脂肪酸结合蛋白在川崎病患儿中的变化及其临床意义

目的：通过测定川崎病（KD）患儿血清心型脂肪酸结合蛋白(h-FABP)水平变化,以探讨h-FABP在反映KD患儿心肌损害中的临床价值。方法：选择40例KD患儿为研究对象,以30例正常儿童为对照组。对KD组及对照组采用酶联免疫吸附法检测血清h-FABP、肌钙蛋白I（cTnI）,同时利用杜邦全自动生化分析仪检测肌酸磷酸激酶同功酶（CK-MB）。并行心脏彩色多普勒(UCG)检测冠状动脉内径,将KD组分为冠状动脉病变（CAL）组和非冠状动脉病变（NCAL）组。结果：KD组血清h-FABP浓度、阳性率与对照组比较差异有显著性（P<0.01）,cTnI浓度及阳性率明显高于对照组(P<0.05),而CK-MB浓度和阳性率与对照组比较差异无显著性（P>0.05）;h-FABP与cTnI阳性率比较差异有显著性（P<0.01）;CAL组和NCAL组血清h FABP浓度对比差异有显著性（P<0.01）。结论：血浆h-FABP、cTnI浓度可作为KD患儿早期心肌损害的生化标志物,而h-FABP具有更高的灵敏度和特异性;血浆h-FABP浓度对川崎病以及川崎病合并冠状动脉病变的早期诊断、指导治疗具有重要的临床意义。     

Use of Intravenous γ-Globulin for Kawasaki Disease: Effects on Cardiac Sequelae

The administration of intravenous γ-globulin (IVGG) for Kawasaki disease was investigated throughout Japan in 1993 by obtaining information from pediatric departments in 2652 hospitals that had more than 100 beds. Of 11,221 reported patients, 8958 patients (79.8%) received IVGG treatment. Of all the patients to whom IVGG was administered, the most common total dose was 1000 mg/kg (36.3%) followed by 2000 mg/kg (16.9%) and 1200 mg/kg (16.8%). The treatment was started in 53.8% by day 5 of the illness and in 83.7% by day 7. The proportion of those with cardiac sequelae was higher among patients administered >2000 mg/kg or in those started on IVGG on day 9 of their illness or later. The possible reasons are (1) those who were more severely affected were treated with high-dose IVGG earlier; or (2) IVGG does not effectively prevent cardiac sequelae. We concluded that there is a risk of unfavorable effects with IVGG regarding cardiac sequelae when the IVGG dose is >2000 mg/kg or if IVGG is started on day 9 or later. We believe that only a randomized controlled trial, undertaken prospectively, can adequately address the question of the optimal use of IVGG.