儿童过敏性紫癜并发心肌损害时心肌酶谱及肌钙蛋白的变化

Variation and clinical significance of myocardial enzymes and troponin in children with Henoch- Sch6nlein purpura and concurrent myocardial injury

背景：目前，过敏性紫癜患儿心肌损伤引起临床广泛关注。目的：探讨儿童过敏性紫癜并发心肌损害时心肌酶谱、肌钙蛋白的变化及临床意义。方法：对青岛大学附属医院近6年收治的43例过敏性紫癜并发心肌损害住院患儿的临床资料进行回顾性分析，其中选择单纯皮肤型及仅单脏器受累者18例作为单纯组，多脏器受累者25例作为混合组。结果与结论：发病初期天门冬氨酸氨基转移酶、乳酸脱氢酶、肌酸激酶、肌酸激酶同工酶、α-羟丁酸脱氢酶、肌钙蛋白cTnI均有程度不等的异常，尤以混合型患儿各指标增高显著。所有患儿心肌损害预后较好，各项指标均可在病情稳定后降至正常。结果证实，过敏性紫癜可造成心肌损伤，混合型病例较为多见，心肌酶谱和肌钙蛋白与患儿病情程度有一定的相关性，能较好地反映心肌受损情况。

BACKGROUND： Currently, the myocardial injury in children with Henoch-Scht^nlein purpura （HSP） has drawn wide clinical attention. OBJECTIVE： To discuss the variation and clinical significance of myocardial enzymes and troponin in children with HSP and concurrent myocardial injury. METHODS： The clinical data of 43 children with HSP and concurrent myocardial injury who received treatment at the Affiliated Hospital of Qingdao University in the recent 6 years were reviewed. Among them, 18 cases with the simplex skin purpura or single viscera involved were assigned as the simplex group, and 25 cases with multiple viscera involved were assigned as the mixed group.. RESULTS AND CONCLUSION： There were different degrees of abnormalities in aspartate transaminase, lactate dehydrogenase, creatine kinase, isoenzyme of creatine kinase and hydroxybutyrate dehydrogenase in the early stage of the disease; in particular, the indicators in the mixed group showed a significant increase. All the children had a good prognosis of the myocardial injury, and each indicator dropped to normal level after the disease stabilization. These results confirm that HSP may lead to myocardial injury, which is more common in mixed-type cases; the myocardial enzymes and troponin had certain correlations with the severity of children＇s disease which can better reflect the damaging condition of myocardium and find cardiac injury in time.