血清心肌肌钙蛋白-I、肌酸激酶同工酶对新生儿缺氧缺血性脑病心肌损伤的诊断价值

目的 探讨血清心肌肌钙蛋白I（CTn-I）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）及CK-MB／CK对新生儿缺氧缺血性脑病（HIE）患儿心肌损伤的诊断价值。方法 对2001年8月至2003年12月78例HIE患儿与对照组同期入住新生儿病房26例无缺氧性脑痛的患儿于出生后18～24h取血，分别用快速固相免疫层析法、NAC-免疫抑制法、NAC法测定血清CTn-I、CK、CK-MB并计算CK-MB／CK值。结果 对照组、轻、中、重HIE四组患者间血清CTn-I、CK、CK-MB有显著性差异（P〈0．05）。其中3例重度HIE伴阵发性室性心动过速，CTn-I〉125ng／L；而CK-MB虽有升高，但无明显差异；CK-MB／CK值在各组中无明显差异。结论 重视对HIE患儿心脏功能的监测与治疗，对改善患儿的预后具有非常重要的意义，在评价HIE患儿心肌损伤时，CTn-I是比CK-MB及CK更敏感、更具有特异性的指标，所以CK-MB／CK不宜作为HIE患儿心肌损伤的生化指标。

Diagnostic value of serum cardiac troponin - I and creatine kinase isoenzyme for myocardial damage in neonates with hypoxic - ischemic encephalolmthy

Objective To investigate the diagnostic value of serusm cardiac troponin-I(cTn-I),creatine kinase(CK),creatine kinase isoenzyme(CK-MB) and CK-MB/CK ratios for myocardial damage in neonates with hypoxic-ischemic encephalopathy(HIE).Methods From August 2001 to December 2003,87 neonates with HIE and 26 neonates without HIE(control group) were enrolled in the study.Blood sample were drawn between the hiours of 8 and 24 after birth. Serum cTn-I,CK and CK-MK were tested by Fast Solid Immuno-chromatography,NAC-immunosuppression and NAC methed,respectively.Results Neonates with HIE were divided into 3 groups according to the severity of HIE.There were significant differences in serum cTn-I,CK and CK-MK levels among 4 groups(P<0.05),but CK-MB/CK ratios were not.Three neonates with severe HIE had paroxysmal ventricular tachycardia and serum cTn-I>125ng/L;but serum CK-MB levels were only slightly elevated without statstical significances.In a proportion of neonates with mild HIE without clinical evidence of hypoxic-ischemic myocardial damage,serum CK-MB and CK levels(but not serum CTn-I levels) were abnormally elevated.Conclusion Serum CTn-I level is more sensitive and specific than CK-MB and CK to hypoxic-ischemic myocardial damage.CK-MB/CK should not be used as a diagnostic indicator of hypoxic-ischemic myocardial damage.