心肌肌钙蛋白Ⅰ测定及其在心肌损伤疾病中的意义

目的探讨心肌肌钙蛋白(cTnI)在儿科常见心肌损伤性疾病(病毒性心肌炎、新生儿窒息及肺炎合并心力衰竭)诊治中的作用。方法采用化学发光免疫分析法检测病毒性心肌炎、新生儿窒息及肺炎合并心力衰竭等患儿的cTnI水平,统计其阳性率并与CK-MB阳性率对比。同期出生的正常新生儿作为对照组。结果①病毒性心肌炎组、新生儿窒息组、肺炎合并心力衰竭组、肺炎(无心力衰竭)组cTnI阳性率分别为43%,89%,61%,7%。病毒性心肌炎组cTnI阳性率显著高于CK-MB阳性率(P<0.05)。②新生儿窒息组cTnI阳性率高于病毒性心肌炎组、肺炎合并心力衰竭组,有显著性差异(P<0.05)。③新生儿窒息组cTnI((0.166±0.148)μg/L)较对照组((0.017±0.012)μg/L)显著升高(P<0.01)。结论①cTnI作为心肌损伤的血清学标志物,与CK-MB相比,有更好的敏感性和特异性,有可能成为病毒性心肌炎临床诊断的金标准。②新生儿窒息患儿多数存在心肌损害,提示对窒息患儿要注意给予营养心肌治疗,促进病情好转,降低新生儿死亡率。③对肺炎特别是合并心力衰竭患者要注意及时检测cTnI,判断心肌损伤程度,给予相应治疗。④cTnI明显增高提示预后不良。

Detection of cardiac troponin I and its significance in myocardial injury disease

Objective It is to discuss the action of cardiac troponin I(cTnI) in diagnosis and treatment of frequent myocardial damage disease such as viral myocarditis,neonatal asphyxia and pneumonia combined with heart failure in paediatrics.Methods The cTnI levels of viral myocarditis,neonatal asphyxia and pneumonia combined with heart failure children were detected with chemiluminescent immunoassay.The positive rates were counted and compared with CK-MB positive rates. The normal neonates born at the same time were as control group.Results ① cTnI positive rates in viral myocarditis group,neonatal asphyxia group,pneumonia combined with heart failure group and pneumonia un-combined with heart failure group were respectively 43%,89%,61% and 7%.In viral myocarditis group,cTnI positive rate was significantly higher than CK-MB positive rate(P<0.05).② cTnI positive rate in neonatal asphyxia group was higher than that in viral myocarditis group and pneumonia combined with heart failure group,and there were significant differences among the three groups(P<0.05).③ cTnI value in neonatal asphyxia group((0.166±0.148)μg/L) was significantly higher than that in control group((0.017±0.012)μg/L,P<0.01).Conclusion ① cTnI is as serologic marker and has better sensitivity and specificity compared with CK-MB,and it may be as the gold standard of clinical diagnosis of viral myocarditis.② Neonatal asphyxia children mainly have myocardial damage,which prompts that asphyxia children might be pay attention to give myocardial nutrition medicine to promote pathogenetic condition improving and lower neonate death rate.③ Pneumonia specifically combined with heart failure children should be pay attention to detect cTnI in time,judge the degree of myocardial damage and give corresponding therapy.④ cTnI obviously heightening prompts unfavourable prognosis.