儿童心前区不适病因分析及心肌肌钙蛋白I的诊断价值

Value of cardiac troponin I in the identification of causes of childhood precordial distress

目的儿童心前区不适是较常见的临床主诉,少数是严重心血管疾病的症状,可造成猝死。为了探讨小儿心前区不适的临床特点及病因,该研究检测心肌肌钙蛋白I(cTnI)、ECT心肌灌注显像(MPI)以了解有否存在心肌损害及心肌灌注情况,并比较其相关性。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,摄胸片、检查常规心电图、Holter心电图、超声心动图,测定肌酸激酶同工酶MB(CKMB)、cTnI,部分病例同时进行了MPI检查并按MPI减低程度分4个等级。用等级相关分析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、CKMB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(r=0.974,P<0.01)。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 Precordial distress is a common complaint in the pediatric population resulting from cardiac or non-cardiac diseases. The management approach and the prognosis of precordial distress vary with different causes. Therefore it is important to identify the causes of this complaint. This study examined serum cardiac troponin I (cTnI) levels and other clinical and laboratory parameters in children with this complaint to explore the value of cTnI in identifying the causes of childhood precordial distress. Methods The medical documents of 123 children with precordial distress, including the history, the findings of physical examination, electrocardiogram, ultrasonocardiography and myocardial perfusion imaging (MPI), serum creatine kinase MB isoenzyme (CK-MB) activity and cTnI concentrations, were analyzed retrospectively. cTnI concentrations were detected using enzyme immoassy. The relationship between myocardial perfusion and cTnI concentrations was evaluated by rank correlation analysis. Results A total of 81 patients (65.9%) were diagnosed with non-cardiac disease among 123 cases with precordial distress and all of them had normal cTnI concentrations. The cTnI concentrations were increased above normal in 17 cases, and low myocardial perfusion was found in 36 of 42 children with cardiac diseases. There was a linear correlation between cTnI levels and the severity of myocardial perfusion decrease (r=0.974, P<0.01). Conclusions The majority of childhood precordial distress may be caused by non-cardiac disease. Measurement of cTnI combined with MPI can identify the cause of childhood precordial distress.