窒息新生儿缺氧缺血性心肌损害血清肌钙蛋白-Ⅰ水平及QT离散度的研究

The clinical value of serum cTnI level and QT dispersion to assessing hypoxic-ischemic myocardial damage in newborns with asphyxia

目的探讨不同窒息程度新生儿治疗前后血清肌钙蛋白-I(cTnI)水平变化及QT离散度的变化及其临床意义。方法收集30例轻度窒息新生儿(轻度窒息组),20例重度窒息新生儿(重度窒息组)出生后24h内及治疗后第7天的cTnI与肌酸磷酸激酶同工酶(CK-MB);同时第1天及第7天对收集病例进行心电图检测计算QT离散度,并与围产期无窒息史的20例新生儿(对照组)进行比较。结果窒息组新生儿生后第1天血清cTnI与CK-MB及QT离散度均较对照组明显升高(P均<0.01),且重度窒息组较轻度窒息组cTnI与CK-MB升高更明显(P均<0.01),表明窒息程度越重血清cTnI与CK-MB升高越明显。治疗7d后窒息新生儿cTnI与CK-MB水平及QT离散度均能下降,与治疗前(第1天)比较差异有统计学意义(P均<0.01)。结论 cTnI与CK-MB均能敏感检出窒息新生儿心肌损伤,且随着病情好转cTnI与CK-MB及QT离散度均有明显下降,但由于CK-MB影响因素较多,且活性持续时间较短,目前多用cTnI作为反映心肌损害指标,其联合QT离散度检测能早期敏感检出窒息后缺氧缺血性心肌损害,有助于疗效判断及病情与预后评估。

Objective To explore the changes and clinical significance of serum cardiac troponin I （cTnI） level and QT dispersion in newborns with asphyxia. Methods The levels of cTnI and creatine phosokinase isozyme （CK-MB） and QT dispersion Were detected in 30 newborns with mild asphyxia （ mild asphyxia group） and 20 newborns with severe asphyxia （ severe asphyxia group） both on 1 st day and 7th day and compared with 20 newborns without asphyxia and hypoxic-ischemic myocardial damage history （control group）. Results The levels of cTnI and CK-MB and QT dispersion on 1st day were ob- viously higher in the newborns with asphyxia（ mild and severe asphyxia groups） than those in control group（ all P 〈 0. O1 ）. The levels of cTnI and CK-MB in severe asphyxia group were higher than that in mild asphyxia group （all P 〈 0.01 ）, and the result showed the more serious asphyxia,the more higher of cTnI and CK-MB levels. The cTnI and CK-MB levels as well as QT dispersion in the newborns with asphyxia obviously decreased on 7th day after treatment compared with pre-treatment（ all P 〈 0.01 ）. Conclusions Though all serum cTnI and CK-MB can reflect the myocardial damage, and they obviously decrease with improving of disease condition, cTnI is served as the marker of myocardial damage at present because of more influencing factors and shorter sustained duration of CK-MB activity than cTnI. Detecting cTnI and QT dispersion can early find hypoxie- ischemic myocardial damage in newborns with asphyxia,The serum cTnI level and QT dispersion are helpful in evaluating.the therapeutic effect and judging disease condition and prognosis of hypoxic-ischemic myocardial damage in newborns with asphyxia.