病毒性肝炎合并心肌损伤的临床分析

Clinical analysis of viral hepatitis complicated with myocardial injury

目的探讨病毒性肝炎合并心肌损伤的心肌酶、心电图、超声心动图及临床特点。方法序贯收集158例病毒性肝炎患者的临床资料,对心肌酶异常者行心电图、超声心动图检查。结果甲型肝炎心肌酶谱异常的发生率高于其他型肝炎(P<0.05);病毒性肝炎心肌酶谱异常以肌红蛋白降低、乳酸脱氢酶升高为主;肌红蛋白和乳酸脱氢酶的改变在甲型肝炎与丙型肝炎之间,乙型肝炎与丙型肝炎之间差异有统计学意义(P<0.05);乳酸脱氢酶升高在急性肝炎与慢性肝炎之间差异无统计学意义(P>0.05),肌红蛋白降低在急性肝炎与慢性肝炎之间差异有统计学意义(P<0.05);心肌酶谱的改变在慢性肝炎轻度与重度之间差异有统计学意义(P<0.05),与病毒载量的高低关系不大。病毒性肝炎患者心电图异常66.37%(77/116),超声心动图异常14.43%(14/97),心电图及超声心动图异常与肝炎类型及病毒载量无明显关系。仅2.58%的患者出现心脏症状。结论病毒性肝炎心肌酶谱异常以肌红蛋白降低、乳酸脱氢酶升高为主,心肌酶谱异常与病毒类型有一定关系,与肝脏炎症活动有关,与病毒载量无关。病毒性肝炎患者存在心电图及超声心动图异常,与肝炎类型及病毒载量均无明显关系。肝炎病毒引起心肌损伤多为亚临床表现。

Objective To explore the clinical features of myocardialase spectrum, electrocardiogram and eehocardiography in viral hepatitis patients complicated with myocardial injury. Methods Clinical data including myocardialase spectrum, electrocardiogram and eehocardiography in 158 cases of viral hepatitis patients was collected and analyzed. Results An incidence of abnormal myocardialase spectrum in patients with hepatitis A was higher than in patients with hepatitis B, hepatitis C and hepatitis E （ P 〈 0.05 ）. Main abnormal myoeardialase spectrum was decreasing of myoglobin and increasing of lactic dehydrogenase . There was difference between patients with hepatitis A and hepatitis C, between patients with hepatitis B and hepatitis C （ P 〈 0.05 ）. The difference in decreasing of myoglobin was observed between a- cute hepatitis and chronic hepatitis （ P 〉 0.05 ）, but not existed from increasing of lactic dehydrogenase （ P 〈 0.05 ）. There was difference in myoeardialase spectrum between chronic mild hepatitis and sever hepatitis. Abnormal myocardialase spectrum was not associated with replication status of hepatitis B virus and hepatitis C virus. Abnormal electrocardiogram was observed in 77 cases with an incidence of 66.37% and abnormal echocardiography was observed in 14 cases （ 14.43% ）. The symptoms of palpitation and chest distress only existed in 2.58% of viral hepatitis patients. Conclusion There was decreasing of myoglobin and increasing of lactic dehydrogenase in viral hepatitis patients. The abnormal myocardialase spectrum was associated with kinds of virus and inflammation of liver, but was not associated with replication status of hepatitis virus. There was abnormal electrocardiogram and echocardiography in viral hepatitis patients. The abnormal electrocardiogram and echocardiography was neither associated with kinds of hepatitis nor replication status of hepatitis virus. Myocardial injury of viral hepatitis patients mainly was subclinical.