心肌酶谱及其比值与肌钙蛋白定量测定对儿童病毒性心肌炎的诊断价值

目的初步了解重庆市主城区儿童心肌酶的正常范围,探讨其比值及肌钙蛋白Ⅰ(cTnI)测定对儿童病毒性心肌炎的诊断价值。方法采用OLYMPUS 400全自动生化分析仪测定肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、α-羟丁酸(αHBDH)并计算出CK-MB/CK、αHBDH/LDH比值;CK采用酶耦联测定法,αHBDH、LDH采用连续监测法,CK-MB采用免疫抑制法,cTnI采用胶乳增强免疫比浊法测定。结果 200名健康儿童心肌酶水平均高于健康成人(P<0.01),但不同组别CK-MB/CK<0.03者占80%以上,αHBDH/LDH在0.7～0.9之间占85%以上。80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132例儿童病毒性心肌炎患者中心肌酶异常者107例(占80%),CK-MB/CK>0.07者80例,αHBDH/LDH>0.9者78例,cTnI结果阳性90例。其比值和cTnI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,儿童心肌酶单项升高不能作为病毒性心肌炎的诊断依据;CK-MB/CK>0.07、αHBDH/LDH>0.9以及cTnI结果阳性对诊断病毒性心肌炎有极大的临床价值。

Diagnostic value of measurement of myocardial enzymes and their ratio and cTnI in children viral myocarditis

Objective To inquire the normal range of children myocardial enzymes in the local area,and to study the diagnostic value of the ratio and cardiac troponin Ⅰ（cTnI） in children viral myocarditis（VMC）.Methods Creatine kinase（CK）,lactate dyhydrogenase（LDH）,and α hydrooxybutyrate dehydrogenase（αHBDH） were detected by cotinuous monitoring assay and creatine kinase isoenzyme MB（CK-MB） by immunity restrain assay with Olmypus 400 complete automatic biochemistry analyzer,and CK-MB/CK,and αHBDH/LDH were calculated.cTnI was measured by solid phase immunochromatographic method.Results The level of myocardial enzymes was significantly higher in 200 cases of healthy children than that of healthy adults in the local area（P0.01）.The percentage of CK-MB/CK 0.03 subjects was over 80%,of α-HBDH/LDH 0.7-0.9 ones was over 85%.The levels of myocardial enzymes exceeded children′s normal reference range after sports,but the ratios did not go up.In 132 cases of definitely-diagnosed viral myocarditis,107 cases suffered from myocardial abnormality（80%）.80 cases were with CK-MB/CK0.07,and 78 cases αHBDH/LDH 0.9.90 cases cTnI positive.The ratio was associated with cTnI level via matched test.Conclusion Children myocardial enzyme normality can not be judged by adult standards.The elevation of a single children′s myocardial enzyme can not be regarded as diagnostic basis.CK-MB/DK 0.07,αHBDH/LDH 0.9 and cTnI positive result contribute to the diagnosis of viral myocarditis.