心肌酶及其比值和肌钙蛋白的测定对儿童病毒性心肌炎诊断价值探讨

目的:初步了解本地区儿童心肌酶的正常范围,探讨其比值及肌钙蛋白I(cTnI)对儿童病毒性心肌炎(VMC)的诊断价值。方法:采用日立7170A全自动生化分析仪来测定肌酸激酶(CK)、肌酸激酶同工酶MB(CK-MB)、乳酸脱氢酶(LDH)、α-羟丁酸(α-HBDH)并计算出CK-MB/CK、α-HBDH/LDH;CK采用酶偶联测定法,α-HBDH采用连续监测法,LDH采用连续监测法(LDH-L),CK-MB采用免疫抑制法;cTnI采用固相层析免疫分析法测定。结果:本地区100例健康儿童心肌酶水平均高于健康成人(P<0.01),但不同组的CK-MB/CK<2%的占85%以上,α-HBDH/LDH在0.6~0.8之间占87%以上。50名健康儿童运动后的心肌酶普遍高出儿童正常范围,但其比值并未升高。已确诊的66例儿童病毒性心肌炎患者的心肌酶异常的有55例(占84%),CK-MB/CK>6%的有41例,α-HBDH/LDH>0.8的有39例,cTnI结果阳性的有46例,比值和cTnI的结果经配对检验,存在一致性关联。结论:不能用成人的标准来判断儿童心肌酶异常与否,儿童心肌酶单项升高不能作为VMC的诊断依据;CK-MB/CK>6%、α-HBDH/LDH>0.8以及cTnI结果阳性对诊断VMC有极大的临床价值。

Study the Diagnosis Value on the Measurement of Cardiac Muscle Enzyme and His Ratio and CTnl in Child's Virus Myocarditis

Objective To inquire the normal range of children cardiac muscle enzyme in local area,and study the diagnosis value of the ratio and cardiac troponin I(cTnI)in child virus myocarditis(VMC).Methods Measuring Creatine Kinase(CK),Lactate Dyhydrogenase(LDH),α-Hydrooxybutyrate Dehydrogenase(α-HBDH)with cotinuous monitoring assay and Creatine Kinase Isoenzyme MB(CK-MB)with immunity restrain assay with Hitachi 7 170 A complete automatic biochenistry analyser,and counting out CK-MB/CK,α-HBDH/LDH.Measuring cTnI with solid each other layer unpack immunity analysis assay.Results 100 examples healthy children's cardiac muscle enzymeall are more than health adults'(P<0.01)in localarea.But more than 85% of CK-MB/CK is smaller than 2%,more 87% of α-HBDH/LDH is between 0.6～0.8 in the difference team.50 healthy children's cardiac muscle enzyme universally exceed children's normal range after sport,but their ratios do not go up.55 examples'(occupying 84%)cardiac muscle enzyme are unusual in 66 examples children virus myocarditis patients made a definite diagnosis.41 examples'cTnI are greater than 6%,39 examples'α-HBDH/LDH are greater than 0.8,and 46 examples'cTnI are positive.The ratio and cTnI exists compatibility through couple test.Conclusions Can not use adults' standard to judge that whether children's cardiac muscle enzyme is unusual or not.Individual upper children' cardiac muscle enzyme can not regard as the diagnosis basis of VMC.If CK-MB/CK is greater than 6%,α-HBDH/LDH is greater than 0.8 as well as cTnI is positive,their have very big clinical value to diagnose VMC.