儿童轮状病毒性肠炎并发心肌损害的影响因素研究

The Influencing Factors for Rotavirus Enteritis Complicated with Myocardial Damage in Children

目的 探讨儿童轮状病毒（RV）肠炎并发心肌损害的影响因素.方法 回顾性分析2010年9月-2014年5月在潍坊医学院附属潍坊市人民医院小儿内科确诊为RV肠炎的350例患儿的临床资料,根据肌酸激酶同工酶（CK-MB）、心肌肌钙蛋白Ⅰ（cTnⅠ）及心脏器械检查结果将其分为心肌损害组和无心肌损害组,其中心肌损害组220例,无心肌损害组130例.对14个可能与心肌损害发生有关的因素进行单因素分析,包括性别、年龄（0～1岁）、发热、病程（＞5 d）、腹泻次数（＞10次/d）、重度脱水、呕吐、代谢性酸中毒（代酸）、白细胞总数（WBC）、中性粒细胞百分比（N％）、血红蛋白（rHb）、超敏C反应蛋白（hs-CRP）、血钠及血钾;对单因素分析中差异有统计学意义的因素进行Logistic回归分析.结果 单因素分析显示,心肌损害组的年龄（0～1岁）、呕吐、代酸、血钠及血钾水平与无心肌损害组比较,差异有统计学意义（P＜0.05）;多因素Logistic回归分析显示,年龄为0～1岁、呕吐及代酸对儿童RV肠炎并发心肌损害的影响有统计学意义（P＜0.05）.结论 儿童RV肠炎并发心肌损害与多种因素有关,其中年龄为0～1岁、呕吐及代酸可能是心肌损害的独立危险因素.儿童RV肠炎起病隐匿,症状不典型,重症病较少,对1岁以内伴有严重呕吐和代酸的RV肠炎患儿,应行常规心脏标志物检查,必要时应行心脏器械检查,以便早期发现心肌损害并做出及时处理.

Objective To explore the influencing factors of myocardial damage complicated with rotavirus enteritis in children. Methods The clinical data from 350 cases diagnosed with rotavirus enteritis in the Affiliated People Hospital of Weifang Medical University from 2010 - 09 to 2014 - 05 were retrospectively analyzed and were divided into myocardial damage group （ 220 cases） and non - myocardial damage group （ 130 cases） according to isoenzyme of creatine kinase （ CK - MB）, and （or） cardiac troponin （cTnI） and cardiac equipment examination results, 14 probable risk factors such as gender, age （0 ～ 1 ）, fever, course of disease （ 〉 5 d）, the number of diarrhea （ 〉 10 times/d）, severe dehydration, vomiting, metabolic acidosis, white blood cell count （ WBC）, percentage of neutrophils （ N% ）, hemoglobin （ Hb）, high sensitive - C reactive protein （CRP）, sodium, potassium were undergone single factor analysis and then the significant factors were undergone multiple factor Logistic regression analysis. Results Single factor analysis showed that the differences in age （0 ～ 1 ）, vomiting, metabolic acidosis, sodium, potassium between the two groups were significant （ P 〈 0. 05 ） . Multivariate logistic regression analysis showed that age （0～ 1 ） , vomiting, metabolic acidosis were the independent risk factors of children with rotavirus enteritis combined with cardiac damage （ P 〈 0.05 ） . Conclusion More factors are related to myocardial damage in children with RV enteritis, among which age （0 ～1 ）, vomiting and metabolic acidosis may be the independent risk factors. RV enteritis in children is often featured by insidious onset, atypical symptoms and rare severe disease, so routine cardiac markers or cardiac devices detection should be arranged for those less than one year of age accompanying severe vomiting and metabolic acidosis in order to find myocardial damage early.