巨细胞病毒肝炎患儿合并心肌损伤的临床特点分析

Analysis of clinical characteristics of children of cytomegalovirus hepatitis complicated with myocardial damage

目的探讨巨细胞病毒(CMV)肝炎患儿合并心肌损伤的心电图及心肌酶谱变化,为临床诊治提供一定的依据。方法 48例CMV肝炎患儿以入院时未予治疗前血CMV-DNA拷贝数≤1×104为组Ⅰ(25例),>1×104为组Ⅱ(23例),同时选择同期行体检的35例健康婴儿作为正常组,分析三组婴儿心电图及心肌酶谱变化。结果 48例CMV肝炎患儿中合并心肌损伤35例,占72.9%。心电图异常15例,分别为窦性心动过速11例,ST-T改变3例,房性早搏1例。组Ⅰ、组Ⅱ患儿治疗前谷草转氨酶(AST)、肌酸激酶(CK)、同工酶(CK-MB)、乳酸脱氢酶(LDH)均较正常组明显升高,差异有统计学意义(P<0.05);治疗前组Ⅱ较组Ⅰ患儿AST、CK、CK-MB升高,差异有统计学意义(P<0.05);组Ⅰ、组Ⅱ患儿治疗后较治疗前AST、CK、CK-MB、LHD均有所下降,差异有统计学意义(P<0.05);两组患儿治疗后与正常组心肌酶对比差异无统计学意义(P>0.05)。结论 CMV肝炎患儿易发生心肌损伤,病毒负荷越大,心肌损伤越重;其心电图改变多为非特异性,可通过CK-MB等心肌酶检测早期发现。给予及时治疗,心肌损伤绝大部分可恢复正常。

Objective To investigate the changes of electrocardiogram and myocardium enzymogram in children of cytomegalovirus （CMV） hepatitis complicated with myocardial damage, so as to provide reference for clinical diagnosis and treatment. Methods A total of 48 children with CMV hepatitis were divided into group Ⅰ with CMV-DNA copy number≤1×10^4（25 cases） and group Ⅱ〉 1×10^4（23 cases）. The 35 healthy children at the same period were in the control group. Changes of electrocardiogram and myocardium enzymogram in the three groups were analyzed. Results Among the 48 children of CMV hepatitis, there were 35 cases complicated with myocardial damage, accounting for 72.9%. In 15 cases with electrocardiographic abnormality, there were 11 cases with nodal tachycardia, 3 cases with ST-T change, and 1 case with atrial premature beats. Group I and group lI had obviously increased aspartate transaminase （AST）, creatine kinase （CK）, creatine kinase- MB （CK-MB）, lactate dehydrogenase （LDH） than the control group before treatment, and the difference had statistical significance （P〈0.05）. Before treatment, the group Ⅱ had higher AST, CK, and CK-MB than the group Ⅰ. The difference had statistical significance （P〈0.05）. After treatment, both group Ⅰ and group Ⅱ had lowered AST, CK, CK-MB, and LHD. The difference had statistical significance （P〈0.05）. There was no statistically significant difference of myocardial enzyme in the three groups after treatment （P〉0.05）. Conclusion Myocardial damage is common in children with CMV hepatitis, and the greater of viral load, the severer myocardial damage. The change of electrocardiogram is non-specific, and it can be found by early detection of CK-MB. Timely treatment can promote rehabilitation of most myocardial damage.