胎盘早剥早产儿心肌损伤标志物水平及其临床价值

Research of Myocardial Injury Markers in Placental Abruption Premature Infant

目的：探讨胎盘早剥（PA）早产儿心肌损伤生化标志物心肌酶谱（MES）和心肌肌钙蛋白（cTn）Ⅰ的水平变化及临床价值。方法采用计算机随机数字生成器 V1.5随机选择2010年6月至2013年5月于随州市妇幼保健院分娩并收治入新生儿重症监护中心（NICU）治疗的338例 PA早产儿中的87例为研究对象,并纳入观察组（n=87）,选择同期于本院分娩的87例不明原因早产儿为对照组（n=87）。于两组早产儿生后第1,3,7,14天4个时间点检测其心率、心音、MES、cTnⅠ、心电图和超声心动图（本研究遵循的程序符合随州市妇幼保健院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意,并与之签署临床研究知情同意书）。两组早产儿性别、日龄等比较,差异均无统计学意义（P＞0.05）。结果①两组早产儿胎龄、出生体质量、心肌损伤、心律失常、心音减弱、心电图异常和超声心动图异常方面比较,差异均有统计学意义（P＜0.05）。两组患儿4个时间点MES和cTnⅠ水平比较,差异均有统计学意义（P＜0.05）,同组内4个时间点 MES 和 cTnⅠ水平比较,差异亦有统计学意义（P＜0.05）；③两组患儿MES和cTnⅠ平均值均在生后1~3 d迅速增高并达到峰值,生后7 d开始下降,生后14 d观察组早产儿磷酸肌酸激酶（CK）、磷酸肌酸激酶同工酶（CK-MB）和 cTnⅠ水平仍高于正常参考值,其余各酶水平均降至正常。结论动态监测PA早产儿 MES和 cTnⅠ水平,当其异常增高时,结合患儿临床症状、心电图和超声心动图结果可作为早期发现心肌损伤的主要依据,有利于及时进行早期干预,降低并发症发生率。

Objective To explore level changes of myocardial injury markers including myocardial enzymes spectrum （MES）and cardiac troponin （cTn）Ⅰ in placental abruption （PA）premature infants,and provide scientific evidence for early interventions of myocardial injury on PA.Methods From June 2010 to May 2013,a total of 87 placental abruption （PA）premature infants were included in the study as observation group（n=87）.Meanwhile,another 87 premature infants who had healthy mothers were accepted as control group（n= 87）.Their heart rate,heartsound,MES,cTnⅠ,electrocardiogram （ECG）and ultrasonic cardiogram（UCG）were determined at the first,third,seventh and fourteenth days after birth.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Suizhou Women and Children′s Health Hospital.Informed consent was obtained from each participants′s parents.There had no significant differences in gender and age between two groups （P〉0.05）.Results There had significant differences in gestational age,birth weight,total incidence of arrhythmia,dull heart sounds,abnormal ECG and UCG between two groups （P〈0.05 ）.The levels of MES and cTnⅠ in observation group were obviously higher than those of control group at four different observation time points （P〈0.01）.MES and cTnⅠ levels of both groups peaked at 1-3 days after birth and declined to normal until the fourteenth day except phosphocreatine kinase （CK）,creatine kinase isoenzyme （CK-MB）and cTnⅠ of the observation group.Conclusions Dynamic monitoring of MES and cTnⅠ in PA is an effective method to detect myocardial inj ury as early as possible,which can reduce complications.