心肌损伤标志物检测在诊断病毒性心肌炎中的价值

摘要:目的　探讨联合检测心肌损伤标志物对心肌炎患儿心肌损伤的诊断价值。方法　对64例病毒性心肌炎（VMC）患儿、56例非病毒性心肌炎（NVMC）患儿和52名健康对照儿童，分别检测2种心肌损伤标志物心肌肌钙蛋白I（cTn I）、肌酸激酶同工酶（CK-MB）和5种心肌酶活性。结果　检测cTn I 和CK-MB诊断心肌炎敏感性分别为71.88%和68.75%，差异无统计学意义（χ2＝0.15，P＝0.70）；特异性分别为96.30%和65.74%，差异有统计学意义（χ2＝32.78，P＜0.001）；准确性分别为87.21%和66.86%，差异有统计学意义（χ2＝20.13，P＜0.001）。检测cTn I 和CK-MB对心肌炎诊断指数分别为0.68和0.34；阳性预告值分别为92.00%和54.32%，差异有统计学意义（χ2＝20.41，P＜0.001）；阴性预告值分别为85.25%和78.02%，差异无统计学意义（χ2＝1.86，P＝0.17）；联合检测cTn I 与CK-MB诊断心肌炎敏感性为84.38%、特异性为100%、准确性为94.19%、诊断指数为0.84、阳性预告值为93.10%、阴性预告值为91.22%。结论　联合检测cTn I与CK-MB诊断VMC的敏感性、特异性、准确性、阳性预告值与阴性预告值，均高于单一检测，对诊断病毒性心肌炎效果更好。

Role and effect of diagnosis viral myocarditis with by combined detection of cardiac markers

Abstract: Objective To study the diagnostic value of myocardial damage in children with viral myocarditis by combined detection of cardiac markers. Methods The concemmtions of 2 kinds of cardiac marks of cardiac tropenin I (cTn I), ereatine klilase isoenzyme MB mass (CK-MB mass), and 5 kinds of myocardial cnzymes in 64 patients with viral myocarditls (VMC) and 56 patients with non-viral myocarditis (NVMC) and 52 healthy children were detected, respectively. Results The diagnostic efficiencies of cTn I, CK-MB mass for myocardial damage in VMC patients were 71.88％and 68.75% in sensitivity (SE). There was no statistically significant significance (χ2=0.15, P=0.70). 96.30% and 65.74% in specificity (SP), there was statistically significant significance (χ2=32.78, P<0.001). 87.21% and 66.86% in accllracy (AC), there was statistically significant significance (χ2=20.13, P<0.001). Detection of cTn I, CK-MB on the diagnosis of myocarditis index were 0.68 and 0.34. 92.00% and 54.32% in positive predictive value (PPV), there was statistically significant significance (χ2=20.41, P<0.001). 85.25% and 78.02% in negative predictive value (NPV), there was no statistically significant significance (χ2=1.86, P=0.17). The diagnostic effieieney of combined determination of cTn I, CK-MB mass for myocardial damage in VMC patients were 84.38% in sensitivity (SE), 100% in specificity (SP), 94.19％in accllracy (AC), 0.84 and 0.84 in diagnostic index, 93.10% in positive predictive value (PPV), 92.22％in negative predictive value (NPV). Conclusion The diagnostic effieieney of combined determination of cTn I, CK-MB mass for myocardial damage in VMC patients in sensitivity (SE), in specificity (SP), in accllracy (AC), in positive predictive value (PPV), in negative predictive value (NPV), higher than the single detection, viral myocarditis effect is better In the diagnosis.