发热伴血小板减少综合征心肌酶谱动态变化的临床研究

A Clinical Investigation of Kenetics of Mycard Zymogram in the Patients with Fever and Thrombocytopenia Syndrome

目的探讨本地区发热伴血小板减少综合征患者的发热期、多器官功能障碍期、恢复期三期的心肌酶谱的动态变化规律及各期心肌损伤的特点及临床意义。方法对本院2011年5月~2014年8月收住院的86例既往无心脏疾患的发热伴血小板减少综合征患者，回顾性分析其三期心肌酶谱的动态变化，86例患者入院次日早晨采空腹静脉血4ml送检心肌酶谱，后每2日行心肌酶谱检查1次，至恢复正常为止，平均每人查心肌酶谱7．2次。记录其数据，进行统计学分析。结果发热期所有患者的心肌酶谱异常，AST、CK、CK—MB、A—HBDH明显升高，特别是CK、CK—MB显著上升，多器官功能障碍期心肌酶谱异常改变达到高峰，恢复期逐渐下降至正常。说明发热伴血小板减少综合征患者心肌酶谱异常出现早，而恢复相对较快。另外SFTS普通型与危重型患者比较，CK及CK—MB在发热期及多器官功能障碍期，虽都明显升高，但危重型患者心肌酶谱各指标较普通型上升幅度大，两组升高幅度的差异有统计学意义。结论发热伴血小板减少综合征患者的心肌酶谱普遍发生异常改变，且病情越重，心肌酶谱异常越明显，较客观的反映了发热伴血小板减少综合征心肌损害的普遍性及心肌受累程度，故对本病患者应及时做心肌酶谱检测，以便尽早发现心血管系统并发症，及时处理，避免心脏损害相关风险发生，降低病死率。

Objective To learn the dynamic changes of myocard zymogram in the patients with severe fever and thrombocytopenia syndrome （SFTS） in the stages of multiple organ dysfunction and convalescence. Methods A retrospective analysis was performed based on the data from myocard zymogram of 86 inpatients from May 2011 to Augst 2014. Results Myocard zymogram rose from pyrogenetic stage and peaked in multiple organ dysfunction stage and declined in convalescent stage. CK and CKMB presented a sharp increase in the critical cases than in ordinary ones. Conclusions Myocard zymogram changed especially in critically ill SFTS, which reflected the universality and severity and should be detected timely in order to avoid the risks associated with cardiac damage and reduce the fatality rate.