对急性呼吸系统感染患儿血清CK-MB增高的再认识

目的　探讨急性呼吸系统感染患儿血清CK MB增高而无心肌炎临床症状和心电图改变的原因。方法　对急性呼吸系感染患儿于病程的 1～ 5天内采静脉血同时测定CK MB(采用免疫抑制法 )和CTnⅠ (采用夹心ELISA法 ) ,并动态观察病人临床症状、心电图改变以判断是否合并心肌炎。结果　 13 0例急性呼吸系感染患儿中血清CK MB增高 5 8例 ,血清CTnⅠ增高 3例 ,其阳性率为 10 0 % ,经卡方检验P <0 .0 5 ,差异有显著性。 12 7例临床无心肌炎的病例中 ,血清CK MB增高 5 5例 ,正常 72例 ,12 7例患儿中血清CK MB增高组、CK MB正常组与正常儿童对照组三组间CTnⅠ值经方差分析P >0 .0 5 ,差异无显著性。结论　应用免疫法测定的血清CK MB值不能作为判断呼吸系感染时有无心肌损伤的“金指标” ,应改用质量法测定血清CK MB ,或测定血清CTnⅠ来补充。

Recognition on Elevation of CK-MB in Infants Suffering from Acute Respiratory System Infection

Objective　To study the cause of elevation of CK-MB in infants with withont acute respiratory system infection no symptoms of cardititis and abnormal ECG.Method　CK-MB and CTnⅠ were examined in the patients suffering from acute respiratory system infection within 1 tos days.Meanwhile,the clinical symptoms and ECG were dynamically observed in order to conclude whether they were associated with myocarditis.Results　130 cases were studied in which CK-MB elevated in 58 cases,CTnⅠ elevated in 3 cases,3 cases could be made definite diagnoses of myocardititis.The elevation of CTnⅠ was used to prediagnose the positive rate of myocarditis,up to 100 percent(P<0.05).In 127 cases without myocarditis,CK-MB elevated in 55 cases,and was normal in 72 cases.Conclusions　CK-MB examined by immunization is not a gold standard of cadiomyocyte injury during acute respiratory system infection.