动脉导管未闭新生儿血清肌钙蛋白I、磷酸肌酸激酶及其杂化型的表达与意义

Expression and significance of cardiac troponin I,creatine phosphate kinase and its hybrid type in infants with ductus arteriosus

目的探讨动脉导管未闭（PDA）新生儿血清肌钙蛋白I（c Tn I）与磷酸肌酸激酶（CK）、磷酸肌酸激酶杂化型（CK-MB）的表达水平及意义。方法 将2014年1月~2016年1月上海交通大学医学院附属上海儿童医学中心新生儿科治疗的患有动脉导管未闭的37例患儿列为观察组,按照是否合并新生儿呼吸窘迫综合征（NRDS）、是否需要机械通气、有无使用多巴胺再将观察组分成不同亚组（NRDS组和无NRDS组、使用呼吸机组和未使用呼吸机组、使用多巴胺组和未使用多巴胺组）。选择同胎龄、同性别分布的无心脏结构畸形、新生儿窒息的同期住院患儿37例作为对照组。两组新生儿均于生后3~7 d内检测c Tn I、CK及CK-MB水平,比较各组间差异。结果 观察组c Tn I水平显著高于对照组,差异有统计学意义（P〈0.05）,而观察组CK、CK-MB水平与对照组比较差异无统计学意义（P〉0.05）。观察组中使用多巴胺组患儿c Tn I水平显著高于未使用多巴胺组（P〈0.05）。观察组中合并NRDS组与未合并NRDS组、机械通气组与未合并机械通气组的c Tn I、CK、CK-MB比较差异均无统计学意义（P〉0.05）。结论 对出生3~7 d血清c Tn I水平较高的新生儿需密切关注是否存在PDA开放。c Tn I能反映新生儿PDA患儿的心肌损害情况,较CK、CK-MB更为敏感。c Tn I水平较高的PDA患儿可能更易出现多巴胺用药指征下的循环问题。

Objective To measure the different levels of cardiac troponin I （cTnI） and creatine kinase （CK）, creatine kinase MB （CK-MB） in the patent ductus arteriosus （PDA） infants. Methods Thirty-seven neonates who were admitted to Department of neonatology, Shanghai Children＇s medical Center, School of Medicine, Shanghai Jiao Tong University from January 2014 to January 2016 were recruited. Neonates with PDA were assigned to observation group. The observation group was further divided into different subgroups （NRDS group and non-NRDS group, mechanical ventilation group and non-mechanical ventilation group, use Dopamine group and not use Dopamine group） according to whether combination with NRDS, whether the use of mechanical ventilation and Dopamine. Thirty-seven neonates had the same gestational age and the same gender with the observation group and no severe congenital heart disease and asphyxia admitted at the same period were selected as the control group. Levels of cTnI, CK and CK-MB of patients in 3-7 days after birth were tested and compared. Results The cTnI level of observation group was significantly higher than those of the control group （P 〈 0.05）. There was no significant difference in CK and CK-MB level between the observation group and the control group. The cTnI level of the use Dopamine group was significantly higher than that of the not use Dopamine group （P 〈 0.05）. There was no significant difference in cTnI, CK and CK-MB level between NRDS group and non-NRDS group, mechanical ventilation group and non-mechanical ventilation group in the observation group. Conclusion It is needed to be pay close attention to whether there is open PDA for 3-7 days newborn with high level of serum cTnI. cTnI is more sensitive than CK and CK-MB in the myocardial damage of neonates with PDA. Higher cTnI level of neonates with PDA is more likely to occur the circulatory problems of Dopamine medicinal indication,