动态心电图和心肌酶谱对急性上呼吸道感染并发病毒性心肌炎患者的诊断价值

目的探讨动态心电图和心肌酶谱对急性上呼吸道感染并发病毒性心肌炎患者的诊断价值。 方法选取2012年1月至2017年6月于新疆医科大学第五附属医院就诊的急性上呼吸道感染并发病毒性心肌炎的患者123例作为观察组，选取本院同期123例急性上呼吸道感染无其他并发症的人群作为对照组。观察血清肌酸激酶（CK）、肌酸酶同工酶（CK-MB）、天门冬氨酸氨基转移酶（AST）和α-羟丁酸脱氢酶（α-HBDH）水平变化及患者动态心电图和常规心态图的改变特征。 结果入组时，观察组患者血清CK、CK-MB水平显著高于对照组（t = 2.887、P = 0.004，t = 8.872、P < 0.001）；入院第3天始，观察组患者血清CK、CK-MB水平随着治疗时间延长较入院时基线水平呈下降趋势（P均< 0.001）。动态心电图在Ⅰ度房室传导阻滞、Ⅱ度房室传导阻滞、T波改变、QRS低电位和房性早搏的检出率显著高于常规心电图（χ²= 7.899、P = 0.005，χ²= 3.980、P = 0.046，χ²= 10.543、P = 0.001；χ²= 13.934、P < 0.001；χ²= 5.371、P = 0.020）。动态心电图联合心肌酶谱检测急性上呼吸道感染并发病毒性心肌炎的阳性率显著高于心肌酶谱、动态心电图及常规心电图单独应用（P均< 0.05）。 结论动态心电图联合心肌酶谱可提高急性上呼吸道感染并发病毒性心肌炎患者的诊断率。

Diagnostic value of dynamic electrocardiogram and myocardial enzyme spectrum in patients of acute upper respiratory tract infection complicated with viral myocarditis

ObjectiveTo investigate the diagnostic value of dynamic electrocardiogram and myocardial zymogram in patients with acute upper respiratory tract infection complicated with viral myocarditis. MethodsFrom January 2012 to June 2017, a total of 123 patients with acute upper respiratory tract infection complicated with viral myocarditis in the Fifth Affiliated Hospital of Xinjiang Medical University were selected as observation group, while 123 patients with acute upper respiratory tract infection without other complications were selected as control group in this hospital. The levels of serum creatine kinase (CK), creatine kinase isoenzyme (CK-MB), aspartate aminotransferase (AST), α-hydroxybutyrate dehydrogenase (α-HBDH) and hydroxybutyric dehydrogenase were dectected, respectively; and the characteristics of dynamic electrocardiogram change of patients were investigated. ResultsThe levels of serum CK and CK-MB of patients in observation group were significantly higher than those of control group (t = 2.887, P= 0.004, t = 8.872,P < 0.001). Since the third day after admission, the serum CK and CK-MB levels of observation group decreased, with significant difference (bothP < 0.001). The detection rate ofⅠdegree atrioventricular block,Ⅱdegree atrioventricular block, T wave changes, QRS low potential and atrial premature beat in observation group were significantly higher than those of conventional electrocardiogram, with significant differences (χ²= 7.899,P= 0.005; χ²= 3.980,P= 0.046;χ²= 10.543,P= 0.001;χ²= 13.934,P < 0.001;χ²= 5.371,P= 0.020). The positive detection rate of dynamic electrocardiogram combined with myocardial zymogram was significantly higher than that of myocardial enzyme spectrum, dynamic electrocardiogram and routine electrocardiogram alone, with significant differences (allP< 0.05). ConclusionsDynamic electrocardiogram combined with myocardial zymogram could improve the diagnostic rate of acute upper respiratory tract infection complicated with viral myocarditis.