病毒性心肌炎与支原体肺炎患儿心肌损伤标志物水平的检验意义

The Significance of Detecting the Myocardial Injury Marker Levels in Children with Viral Myocarditis and Mycoplasma Pneumonia

目的:探讨病毒性心肌炎与支原体肺炎患者心肌损伤标志物水平检测意义。方法:回顾性分析医院收治的病毒性心肌炎患儿53例和肺炎支原体肺炎患儿49例分别作为病毒性心肌炎组和支原体肺炎组,选取同期体检正常儿童50例作为对照组,分别检测心肌酶指标和心肌蛋白指标。结果:病毒性心肌炎组心肌肌钙蛋白I(c Tnl)、肌红蛋白(MYO)显著高于支原体肺炎组、对照组,差异显著(P<0.05);支原体肺炎组和对照组组间差异显著,具有统计学意义(P<0.05)。病毒性心肌炎组肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)均显著高于支原体肺炎组、对照组,差异显著(P<0.05);支原体肺炎组、对照组组间对比差异显著,具有统计学意义(P<0.05)。2组入院10 d c Tnl、MYO均低于入院第1 d,具有统计学意义(P<0.05);病毒性心肌炎组入院第10 d c Tnl、MYO显著高于支原体肺炎组,具有统计学意义(P<0.05)。2组入院10 d CK、CK-MB、AST、LDH均低于入院第1 d,具有统计学意义(P<0.05);病毒性心肌炎组入院第10 d CK、CK-MB、AST显著高于支原体肺炎组,差异具有统计学意义(P<0.05)。根据ROC曲线分析临床性能,c Tnl、MYO、CK、CK-MB、AST、LDH的临界值分别为0.38μg/L、56.2μg/L、236.58 U/L、32.8 U/L、71.6 U/L、232.8 U/L,灵敏度分别为82.7%、85.4%、84.8%、89.6%、90.2、79.8%。结论:心肌损伤标志物可作为诊断病毒性心肌炎和支原体肺炎的重要指标,应用ROC回归曲线确定各指标的临界值,还可对两种疾病进行鉴别诊断。

Objective： To investigate the significance of detecting the myocardial injury marker levels in patients with viral myocarditis and mycoplasma pneumonia. Methods： 53 cases of children with viral myocarditis and 49 cases with mycoplasma pneumoniae treated in the hospital were retrospectively analyzed and were respectively included in the viral myocarditis group and the mycoplasma pneumonia group. 50 cases of normal children in the same period were selected as the control group. The myocardial enzyme indexes and myocardin indexes were detected respectively. Results： The cardiac troponin I（c Tnl） and myohemoglobin（MYO） of the viral myocarditis group were significantly higher than those of the mycoplasma pneumonia group and the control group（P〈0.05） and the differences between the mycoplasma pneumonia group and the control group were statistically significant（P〈0.05）. The creatine kinase（CK）, creatine kinase isoenzyme（CK-MB）, aspartate aminotransferase（AST） and lactic dehydrogenase（LDH） of the viral myocarditis group were significantly higher than those of the mycoplasma pneumonia group and the control group（P〈0.05） and the differences between the mycoplasma pneumonia group and the control group were statistically significant（P〈0.05）. 10 d after admission, c Tnl and MYO of the 2groups were lower than those on the first day after admission（P〈0.05）; 10 d after admission, c Tnl and MYO of the viral myocarditis group were significantly highe than those of the mycoplasma pneumonia group（P〈0.05）. 10 d after admission, CK, CK-MB, AST and LDH of the 2 groups were lower than those on the first day after admission（P〈0.05）. 10 d after admission, CK, CK-MB and AST of the viral myocarditis were significantly higher than those of the mycoplasma pneumonia group（P〈0.05）. According to ROC analyzing clinical performance, the critical values of c Tnl, MYO, CK, CK-MB, AST and LDH were 0.38 μg/L, 56.2 μg/L, 236.58 U/L, 32.8 U/L, 71.6U/L and 232.8 U/L respectively. The sensitivities were 82.7%, 85.4%, 84.8%, 89.6%, 90.2 and 79.8% respectively. Conclusion： Myocardial injury markers can be used as important indexes in the differential diagnosis of viral myocarditis and mycoplasma pneumonia. Applying ROC regression curve in determination of the critical values of indexes can be adopted in differential diagnosis of the two diseases.