儿童心前区不适病因探讨及心肌肌钙蛋白Ⅰ的诊断价值

目的探讨小儿心前区不适的病因及临床特点,用心肌肌钙蛋白I(cTnI)检测是否存在心肌损害,ECT心肌灌注显像(MPI)了解心肌灌注情况,并比较它们的相关性。方法对123例心前区不适的患儿行详细的病史采集,体格检查,胸片,常规心电图,Holter心电图,超声心动图检查,肌酸激酶同工酶-MB(CK-MB)、cTnI测定,部分病例同时进行了MPI检查,比较cTnI与心肌灌注减低程度的相关性。结果123例患儿中81例(65.9%)临床诊断为非心源性疾病,cTnI、CK-MB均正常。42例(34.1%)诊断为心源性疾病,17例cTnI升高,36例心肌灌注有不同程度的减低。等级相关分析显示cTnI平均值与MPI减低程度呈正相关。结论儿童心前区不适大多为非心源性疾病,cTnI可提高诊断的特异性,其平均值与MPI减低程度呈正相关,结合ECT可提高儿童心肌损害的诊断水平。

Objective To study the clinical features and causes of precardial distress in children . Methods A hundred twenty-three cases were investigated by careful collection of case history, physical examination, electrocardiogram, Holter ECG, ultrasonocardiography and serum creatine kinase MB isoenzyme (CK-MB) activity ,serum cardiac troponin I (cTnI) an, myocardial perfusion imaging (MPI) with SPECT in some cases and analyzed the (relationship) between cTnI values and MPI severity by Rank correlation. Results Eighty-one cases (65.9%) were diagnosed to be non-cardiac illness and in normal value for cTnI and CK-MB. Forty-two cases were diagnosed to be cardiac original. increased someway in 17 cases for cTnI and decreased for MPI in 36 cases .Out of which 17 cases had elevation of cTnI, 36 cases had abnormal ECT results. Moroever,the lower the MPI severity, the higher was the sensitivity of cTnI. Conclusion The most cause of precardial distress in children is non-cardiac illness. CTnI is more specific than ECT in (diagnosing) (cardiac) injury. Measurement of cTnI together with ECT (imaging) can accurately detect cardiac injury in children with precardial distress.