病毒性心肌炎患儿心肌损伤标志物检测分析

Analysis of Combined Determination of Myocardial Injury Markers in Children with Viral Myocarditis

目的:探讨联合检测心肌损伤标志物对病毒性心肌炎(VMC)患儿心肌损伤的诊断价值。方法:对52例VMC、58例非病毒性心肌炎(NVMC)患儿和50例健康对照者,分别检测血清3种心肌损伤标志物[心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶MB质量(CK-MBmass)、肌红蛋白(MYO)]浓度和4种心肌酶活性。结果:入院当日VMC组cTnI(0.41±0.19)μg/L、CK-MBmass(6.02±3.89)μg/L、MYO(102.33±41.42)μg/L,均明显比NVMC组和对照组高(P<0.01);联合检测cTnI、CK-MBmass和MYO对VMC心肌损伤的诊断灵敏度(SE)、特异性(SP)、阳性预报值(PPV)、阴性预报值(NPV)和准确度(AC)分别为71.15%、96.30%、90.24%、87.39%和88.13%;SE和NPV与联合检测4种心肌酶相近(P>0.05),而SP、PPV和AC却明显比联合检测4种心肌酶高(P<0.01)。结论:联合并动态检测3种心肌损伤标志物比联合检测4种心肌酶能够为VMC心肌损伤的诊断、治疗和预后转归判断提供更好的诊断方法。

Objective：To study the diagnostic value of myocardial damage in children with viral myocarditis by combined detection of cardiac markers. Methods： The concentrations of 3 kinds of cardiac markers of cardiac troponin I （cTnI）, creatine kinase isoenzyme MB mass （ CK-MB mass）, myoglobin （MYO） and 4 kinds of myocardial enzymes in 52 patients with viral myocarditis （VMC） and 58 patients with non-viral myocarditis （NVMC） and 50 healthy children were detected, respectively. Results： The study revealed that VMC patients had obviously higher levels of cTnI, CK-MB mass and MYO compared with those in NVMC group and controls （ P 〈 0. 01 ）. The concentrations of cTnI, CK-MB mass and MYO in VMC group were （0.41 ±0.19） μg/L, （6.02±3.89）μg/L and （102.33 ±41.42）μg/L, respectively. The diagnostic efficiency of combined determination of eTnI, CK-MB mass and MYO for myocardial damage in VMC patients were 71.15% in sensitivity （SE） , 96.30% in specificity （SP） , 90.24% in positive predictive value （PPV） , 87.39% in negative predictive value （NPV） and 88. 13% in accuracy （AC）, respectively. Not only in SE but also in NPV, there were no significant difference between combined detection of 3 kinds of cardiac markers and combined measurement of 4 kinds of myocardial enzymes （ P 〉 0. （15）. However, the SP, PPV and AC of combined detection of 3 kinds of cardiac markers were higher compared with 4 kinds of myocardial enzymes （P 〈 0.01 ）. Conclusions： Combined and continued detection of 3 kinds of cardiac markers can provide better information for diagnosis, treatment and recovery than combined test on 4 myocardial enzymes for myocardial damage in VMC patients.