婴幼儿轮状病毒性肠炎合并心肌损害的临床分析

Clinical analysis of combined myocardial damage induced by rotavirus enteritis in infants

目的分析轮状病毒(RV)感染致心肌损害的状况。方法对2011年9月至2013年3月勉县医院收治的92例腹泻患儿采用酶联免疫吸附试验检测大便中RV抗原,将其分为两组,即观察组(RV抗原阳性组)42例,对照组(RV抗原阴性组)50例,比较两组治疗前及RV抗原阳性组治疗前后心肌酶谱的变化。结果①RV抗原阳性组42例中23例(54.8%)心肌酶谱异常。RV抗原阴性组50例中9例肌酸激酶(CK)、乳酸脱氢酶(LDH)轻度升高,肌酸激酶同工酶(CK-MB)、α-羟基丁酸脱氢酶(HBDH)正常,心肌肌钙蛋白I正常。与RV抗原阴性组比较,RV抗原阳性组CK-MB、α-HBDH、心肌肌钙蛋白I明显升高,差异均有统计学意义,分别为t=8.572,P<0.01;t=2.163,P<0.05;t=2.534,P<0.05。②RV抗原阳性组治疗后心肌酶谱和心肌肌钙蛋白I明显下降(P<0.05)。③心肌损害与发热有相关性;与腹泻程度、电解质紊乱、是否存在脱水无相关性。结论 RV抗原阳性腹泻患儿CK-MB、心肌肌钙蛋白I明显升高,存在心肌损害,应早期发现,早期保护心肌治疗。

Objective To analyze the situation of myocardial damage induced by rotavirus enteritis（ RV） infection. Methods A total of 92 infant who suffered from diarrhea were inspected for RV antigen by enzyme-linked immunosorbent assay （ELISA）from September 2011 to March 2013,and they were divided into two groups：the observation group（RV antigen posi-tive group,42 cases）and the control group（RV antigen-negative group,50 cases）. The change of myocardial enzymes was compared between the two groups before the treatment and among the RV antigen positive group before and after the treatment. Results ① Among 42 cases of RV antigen-positive group,23 cases（54. 8% ）showed abnormalities of myocardial enzyme. Among 50 cases in RV antigen-negative group,9 cases indicate the mild increase of CK,LDH,but their CK-MB,α-HBDH and cardiac troponin I（cTnI）all remain normal. Compared with antigen-negative group,significant elevation of CK-MB,α-HBDH and cTnI can be found among RV antigen positive group. The differences were statistically significant（t = 8. 572,P 〈 0. 01;t =2. 163,P 〈 0. 05;t = 2. 534,P 〈 0. 05,respectively）. ② Myocardial enzymes and cTnI of antigen-negative group revealed a considerable decrease（P 〈 0. 05）. ③ Myocardial damage was correlated with fever;there was no correlation between the seri-ousness of diarrhea,electrolyte imbalance and dehydration. Conclusion The study shows that CK-MB,cardiac troponin I in RV antigen-positive children with diarrhea increased significantly,which may cause myocardial damage. Therefore it should be detec-ted at an earlier stage and myocardial protection should be started as soon as possible.