小儿流行性腮腺炎血清酶学的变化特征

目的：探讨血清肌酸激酶同工酶(CK-MB)、淀粉酶(AMY)、脂肪酶(LPS)、丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)在流行性腮腺炎中的变化特征以及 CK-MB/CK 对流行性腮腺炎合并心肌损害的诊断价值。方法本院住院的流行性腮腺炎病例296例，其中合并胰腺炎21例(胰腺炎组)，合并心肌损害27例(心肌损害组)，合并肝损害54例(肝损害组)，无并发症患儿194例(普通组)。比较各组患儿血清酶学变化特点。结果与普通组比较，胰腺炎组 LPS 水平明显升高(215.5±42.3)U/L vs (402.1±77.2)U/L(P <0.01)，心肌损害组 CK-MB 水平升高(10.6±5.1)mmol/L vs (13.0±4.3)mmol/L(P <0.05)，肝损害组 ALT(19.5±4.3)U/L vs (61.8±9.4)U/L、AST明显升高(21.1±6.1)U/L vs (70.0±10.1)U/L(均 P <0.01)；与胰腺炎组比较，各组 LPS 水平均明显降低(均 P <0.01)，肝损害组 ALT(17.9±4.8)U/L vs (61.8±9.4)U/L、AST(22.0±5.1)U/L vs (70.0±10.1)U/L 明显升高(均 P <0.01)；与心肌损害组比较，肝损害组 AST、ALT 明显升高(P <0.01)。ROC 分析显示 CK-MB/CK 预测心肌损害曲线下面积为0.666。结论血清 CK-MB、AMY、LPS、ALT 和 AST 在流行性腮腺炎病程中存在一定的变化特征，了解其动态变化规律有助于腮腺炎合并症的规范诊疗；CK-MB/CK 预测心肌损害诊断价值有限。

Change features of serum enzymes in patients with pediatric epidemic parotitis

Objective To explore the change features of serum creatine kinase isozyme （CK-MB）,amylase （AMY）,lipase（LPS）,alanine aminotransferase（ALT）and aspartate aminotransferase（AST）in patients with pediatric epidemic parotitis and to investigate the diagnostic value of CK-MB/CK for the cases complicated with myocardial damage.Methods A total of 296 patients with epidemic parotitis hospitalized in our hospital were enrolled in this study,including 21 cases complicated with pancreatitis （pancreatitis group）,27 cases complicated with myocardial damage （myocardial damage group）,54 cases complicated with hepatic damage （hepatic damage group）and 1 94 cases without complication （common group）.Change features of serum enzymes of the four groups were compared.Results Compared with the common group,the level of LPS in the pancreatitis group increased remarkably （215.5±42.3）U/L vs （402.1±77.2）U/L（P 〈0.01）,the level of CK-MB in the myocardial damage group elevated significantly （10.6 ± 5.1）mmol/L vs （13.0±4.3）mmol/L（P 〈0.05）and the levels of ALT and AST in the hepatic damage group also rose sharply （1 9.5±4.3）U/L vs （61.8±9.4）U/L and （21.1 ±6.1）U/L vs （70.0±10.1）U/L（both P 〈0.01）. As compared with the pancreatitis group,the level of LPS in the other three groups decreased obviously （P 〈0.01 each）.The level of ALT and AST in the hepatic damage group （1 7.9 ± 4.8 ）U/L and （22.0 ± 5.1 ）U/L were markedly higher than those in the pancreatitis group and myocardial damage group,respectively （P 〈0.01 each）.The ROC analysis showed that the area under curve of CK-MB/CK for the predication of myocardial damage was 0.666. Conclusion Serum CK-MB,AMY,LPS,ALT and AST show certain changing characteristics during the clinical course of epidemic parotitis.Thus,monitoring the changing regularity of serum enzymes dynamically is helpful for the standard diagnosis and treatment of the complications of parotitis.The diagnostic value of CK-MB/