手足口病合并支气管肺炎患儿心肌酶谱和心电图改变的临床分析

Changes of myocardial zymogram and electrocardiogram in hand-foot and mouth diseases

目的：通过分析手足口病合并支气管肺炎患儿心肌酶谱和心电图的变化，探讨患儿心脏损害情况，以期指导临床诊疗。方法：收集本地区2013年1月～2014年5月因手足口病合并支气管肺炎住院患儿的心肌酶谱和心电图资料，回顾分析其变化的临床特点。结果：选取50例支气管肺炎患儿，其中合并手足口病的25例（ A组），支气管肺炎25例（ B组），两组患儿性别和年龄均无显著差异（P＞0.05）。辅助检查结果显示两组患儿肌酸激酶同工酶（CK-MB）、天冬氨酸氨基转移酶（AST）、乳酸脱氢酶（LDH）、α-羟基丁酸脱氢酶（HBDH）等心肌酶谱以及心电图异常未见明显差别（P＞0.05）。根据EV71 IgM阳性分为EV71阳性组（ C组）12例和EV71阴性组（ D组）13例，两组患儿性别和年龄均无显著差异（ P＞0.05），心肌酶谱以及心电图异常未见明显差别（P＞00.5）。同时根据年龄将手足口病合并支气管肺炎患儿分为婴幼儿组（E组）21例和学龄前儿童组（F组）4例，两组患儿性别无显著差异（P＞0.05），心肌酶谱表达未见明显差别（P＞0.05），心电图异常均出现在婴幼儿组。结论：心肌损害不是手足口病合并支气管肺炎患儿的特异性表现，但是其发生率仍然较高，在临床诊疗中需要关注。对于婴幼儿患手足口病合并支气管肺炎，心电图应该作为常规检查，可能成为早期诊断心肌炎的可靠指标之一。

Objective：To examine the changes of serum myocardial enzyme spectrum and electrocardiogram （ ECG） in children with hand-foot and mouth disease（HFMD） complicated with bronchial pneumonia,and investigate the status of heart injury for guidelines to clinical diagnosis and treatment of this entity.Methods：The data on myocardial enzyme spectrum and ECG were collected in children with HFMD complicated with bronchial pneumonia underg-one treatment from January 2013 through May 2014 in Nanjing area,and clinical characteristics of changes in these data were retrospectively analyzed. Results：Fifty HFMD cases complicated with bronchial pneumonia were finally included,among whom 25 were simple HFMD（group A）,and another 25 were cases complicated with bronchial pneumonia （group B）.There was no significant difference regarding the ages and genders,as well as laboratory find-ings for isoenzyme （ CK-MB） ,aspartate aminotransferase （ AST） ,lactate dehydrogenase （ LDH） ,alpha hydroxybutyrate dehydrogenase （ HBDH） ,and ab-normal ECG in the two groups of patients（P〉0.05）.By positive EV71 IgM results,children with HFMD complicated with bronchial pneumonia were di-vided into EV71 positive （group C,n=12） and EV71 negative （group D,n=13）.The two groups were not significantly different concerning the ages, genders,myocardial enzyme spectrum and abnormal ECG（P〉0.05）.Further analysis by age,we allocated children with bronchial pneumonia to infant （group E,n=21） and pre-school（group F,n=4）,and the two groups showed no significant difference regarding genders and expression of myocardial en-zyme （P〉0.05）.Yet abnormal ECG was found in group E.Conclusion：Children of HFMD complicated with bronchial pneumonia are not specific to my-ocardial injury,yet the incidence remains relatively higher,which requires clinical attention.Routine ECG examination is recommended,for it may serve as a reliable indicator in early diagnosis of myocarditis for infant cases .