传染性单核细胞增多症合并心肌损害患儿的临床症状、心肌酶谱及免疫功能特点分析

探讨传染性单核细胞增多症（IM）合并心肌损害患儿的临床症状、心肌酶谱及免疫功能特点。方法 回顾性分析2020年1月至2021年9月浙江省中西医结合医院儿科收治的154例IM患儿临床资料，按否合并心肌损害筛查病例，将IM患儿分为心肌损害组33例和无心肌损害组121例。分析对比两组患儿临床症状、心肌酶谱、免疫指标、肝功能及血常规指标。结果 心肌损害组患儿胸闷胸痛（21.21%比7.44%，P<0.05）、心动过速（33.33%比6.61%，P<0.001）、心电图异常情况发生率ST改变：27.27%比5.79%，P<0.001；T波改变：12.12%比0.83%，P<0.05；ST-T改变：12.12%比3.31%，P<0.05；窦性心律不齐：15.15%比1.65%，P<0.05]及肌酸激酶同工酶（CK-MB）（35.60±10.84） U/L比（18.22±4.98） U/L，P<0.001]、乳酸脱氢酶（LDH）（464.27±165.03） U/L比（407.12±128.82） U/L，P<0.05]、丙氨酸氨基转移酶（ALT）水平（14.43±70.72） U/L比（95.67±35.09） U/L，P<0.05]均高于无心肌损害组。心肌损害组患儿血清免疫球蛋白A（IgA）、IgM水平及CD3+、CD8+比率均高于无心肌损害组IgA：（1.93±1.16） g/L比（1.32±0.73） g/L，P<0.001；IgM：（2.21±1.34） g/L比（1.88±0.59） g/L，P<0.05；CD3+：（84.79±4.82）%比（81.97±6.50）%，P<0.05；CD8+：（53.70±13.40）%比（46.63±14.67）%，P<0.05]，CD4+/CD8+低于无心肌损害组（0.32±0.17）比（0.57±0.49），P<0.01]。结论 IM合并心肌损害患儿具有胸闷胸痛、心动过速、心电图异常等临床表现，并且血清CK-MB、LDH、ALT、IgA、IgM水平及CD3+、CD8+比率升高，CD4+/CD8+降低。

Analysis of clinical symptoms, myocardial enzyme and immune function characteristics in children with infectious mononucleosis and myocardial damage

To investigate the clinical symptoms, myocardial enzyme and immune function characteristics of children with infectious mononucleosis (IM) with myocardial damage. Methods: The data of 154 children with IM admitted to Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine from January 2020 to September 2021 were retrospectively collected. Children with IM were divided into the myocardial damage group (n=33) and the non-myocardial damage group (n=121) according to whether they had myocardial damage. The clinical symptoms, myocardial enzyme profile, immune indexes, liver function and blood routine indexes were analyzed and compared between the two groups. Results: In the myocardial damage group,the incidence of chest stuffiness and chest pain was 21.21%, the incidence of tachycardia was 33.33%, the incidence of ST segment change, T wave change, ST-T changes and sinus arrhythmia among abnormal ECG were 27.27%, 12.12%, 12.12%, 15.15%. And in the myocardial damage group,the levels of creatine kinase isoenzyme(CK-MB), lactate dehydrogenase (LDH), alanine aminotransferase (ALT), immunoglobulin A (IgA) and immunoglobulin M (IgM) were (35.60±10.84)U/L, (464.27±165.03)U/L, (114.43±70.72)U/L, (1.93±1.16)g/L and (2.21±1.34)g/L. The percentage of CD3+ and CD8+ were (84.79±4.82)% and (53.70±13.40)%. The ratios of CD4+/CD8+ was 0.32±0.17. In the non-myocardial damage group,the incidence of chest stuffiness and chest pain was 7.44%, the incidence of tachycardia was 6.61%, the incidence of ST segment change, T wave change, ST-T changes and sinus arrhythmia among abnormal ECG were 5.79%, 0.83%, 3.31%, 1.65%. And in the myocardial damage group, the levels of creatine kinase isoenzyme(CK-MB),lactate dehydrogenase (LDH), alanine aminotransferase(ALT), immunoglobulin A(IgA) and immunoglobulin M(IgM) were (18.22±4.98)U/L, (407.12±128.82)U/L, (95.67±35.09)U/L, (1.32±0.73)g/L and (1.88±0.59)g/L. The percentage of CD3+ and CD8+ were (81.97±6.50)% and (46.63±14.67)%. The ratios of CD4+/CD8+ was 0.57±0.49. The incidence of chest stuffiness and chest pain, tachycardia, abnormal ECG and the levels of CK-MB, LDH, and ALT in the myocardial damage group were higher than those in the non-myocardial damage group (P<0.05). The levels of IgA and IgM and the percentage of CD3+ and CD8+ in the myocardial injury group were higher than those in the non-myocardial injury group, while the CD4+/CD8+ was lower than that in the non-myocardial injury group (P<0.05). Conclusion: The children with IM combined with myocardial damage showed chest distress, chest pain, tachycardia, abnormal electrocardiogram, and the levels of CK-MB, LDH, ALT, IgA, IgM and the percentage of CD3+ and CD8+ were increased, while the ratio of CD4+/CD8+ was decreased.