29例甲型H1N1流感患者心肌标志物心肌酶的变化及临床意义

Changes of myocardial enzymes in patients with influenza A H1N1 and its clinical significance

目的通过对甲型H1N1流感患者肝酶、心肌酶及心电图变化的研究,探讨甲型H1N1流感患者是否存在心肌损害。方法总结29例临床资料完整而无基础心脏疾病的甲型H1N1流感患者血清天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、肌钙蛋白T(cTnT)和乳酸脱氢酶(LDH)活性的变化规律。并对甲型H1N1流感患者在病程初期和恢复期的心电图变化进行回顾性分析。结果甲型H1N1流感患者血清AST在病程初期即已升高,但其升高幅度小于ALT,并在治疗稳定期基本恢复正常[AST:(52±35)U/L,(30±29)U/L,(21±17)U/L;ALT:(79±54)U/L,(52±37)U/L,(45±54)U/L];CK、LDH亦在病程初期升高,并随病情好转逐渐降低[CK:(441±223)U/L,(318±146)U/L,(229±67)U/L;LDH:(172±101)U/L,(99±77)U/L,(64±49)U/L],但CK-MB、cTnT始终未见异常;9例(31.0%)患者出现一过性的心电图改变(包括窦性心动过速、房性期前收缩、室性期前收缩等情况)。结论甲型H1N1患者血清AST、ALT、CK、LDH呈一过性升高,但cTnT、CKMB不高,甲型H1N1流感病毒引起心肌损害的几率不高。

Objective To investigate the changes of myocardial enzymes in patients with influenza A H1N1 and its clinical significance. Methods A total of 29 patients with influenza A H1N1 and without history of chronic heart and lung disease were enrolled in this study. Serum levels of aspartate transaminase （AST） , glutamie tyruvic transaminase （ALT） , creatine kinase （CK）, creatine kinase-MB （CK-MB）, troponin T （cTnT） and lactate dehydrogenase （LDIt） of each patient were measured and electrocardiogram （ECG） were recorded. Results Serum AST, ALT, CK and IJ）H were elevated at the initial stage of influenza A H1N1 patients and were decreased with the recovery of influenza A H1N1. Serum CK-MB and eTnT remained normal either at initial or at remission stage. Transient ECG changes were noticed in 31. 0% of the patients. Conclusions No evidence in this study shows that influenza A H1N1 can cause myocardial damage.