血清心脏肌钙蛋白I对小儿病毒性心肌炎诊断和转归监测价值

Evaluation of the Effect of Cardiac Troponin I on the Diagnosis and Progress of Viral Myocarditis in Children

目的 评价心脏肌钙蛋白I(cTnI)对小儿病毒性心肌炎的诊断价值 ,探讨其与肌酸激酶同功酶(CK MB)以及病毒性心肌炎的病程、病情演变等之间的关系。方法 采用免疫层析法和速率法测定 38例病毒性心肌炎和 2 4例非心肌炎患儿血清cTnI ,CK MB。间接ELISA法测定柯萨基病毒B1-6IgM (CVB1-6IgM )。 结果 病毒性心肌炎患儿血清cTnI和CK MB阳性率分别为 89.5 % ,6 0 .5 % ,明显高于非心肌炎组 (8.3% ,2 9.2 % )和对照组 (0 ) (P <0 .0 5 )。 82 .4%的血清cTnI阳性出现在病程 1周以内。CVB1-6IgM阳性与阴性组的cTnI和CK MB阳性率差异无显著性。结论 血清cTnI反映心肌细胞损害的敏感性和特异性均高于CK MB ,有较宽的诊断时间窗 ,是一项极具临床价值的心肌炎诊断和转归监测新指标。

Objective To investigate the value of cardiac troponin I (cTnI) compared with creatine kinase isoenzymes (CK MB) in the diagnosis and progress of myocarditis in children. Methods Serum samples from 38 children with viral myocarditis, 24 children with non myocarditis disease and 22 healthy controls were examined for cTnI by the rapid immunochromatographic test and CK MB was examined by enzymatic velocity analysis. CVB 1-6 IgM was determined using ELISA. Results The positive rates of cTnI and CK MB in the myocarditis group were 89.5% and 60.5% , which were significantly higher than those in the non myocarditis group ( 8.3% and 29.2% respectively) and healthy control group (0) (P< 0.05 ). 82.4% of positive cTnI occurred within one week of the onset. There were no differences in the positive rates of cTnI and CK MB between the CVB 1-6 IgM positive group and the negative one. Conclusions The sensitivity and specificity of cTnI in the diagnosis of myocardial injury are superior to the CK MB test and the diagnostic window of cTnI may be wider. cTnI appears to be an excellent new clinical marker for the diagnosis and the evaluation of prognosis of myocarditis.