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

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

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。

Objective To investigate the diagnostic value of serusm cardiac troponin - 1 （ 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 sampie 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 method, respectively. Results Neonates with HIE were divided into 3 groups according to the severity of HIE. There were significant differences in serum cTn - 1, 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 - 1 〉 125ng/L; but serum CK - MB levels were only slightly elevated without statstical siguificances. 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.