心肌损伤标志物在EV71感染重症手足口病诊治中的临床价值研究

Study of clinical value of myocardial injury markers in the diagnosis and treatment of severe hand,foot mouth disease with EV71 infection

目的研究分析EV-71感染重症手足口病患儿,尤其是神经源性肺水肿患儿的心肌损伤特征,探讨心肌损伤标志物对此类患儿病情监测、预后评估的意义。方法收集2012.5-2015.9入住我院感染科病房并接受治疗的手足口病患儿的临床资料,系统整理后进行回顾性分析。共71例患儿纳入分析,均由市级手足口病专家组确诊,均为静脉血EV71-Ig M(+)。分为3组:手足口病肺水肿组共17例,同时期的手足口病脑干脑炎组共21例、同时期的手足口病普通病毒性脑炎组共33例。年龄5月-7岁,平均1.80岁,其中男44例,女27例,男女之比为1.63:1。结果肺水肿组与脑干脑炎组浓度值比较,心肌损伤标志物的浓度值差异存在显著性(P<0.01);肺水肿组的CKMB(肌酸激酶的同工酶)比起脑干脑炎组浓度值要明显升高,但差异没有显著性(P>0.05)。肺水肿组与病毒性脑炎组浓度值比较、脑干脑炎组与病毒性脑炎组浓度值比较,心肌损伤标志物、CKMB的浓度值差异均存在显著性(P<0.05)。17例肺水肿患儿死亡7例,放弃治疗5例,脑干脑炎组放弃治疗2例,二者死亡率差异存在显著性(χ2=15.06,P值<0.01);而普通病毒性脑炎经治疗后基本好转出院。肺水肿组相较于脑干脑炎组、普通病毒性脑炎组,心肌损伤标志物浓度值均存在显著差异,预后也最差。结论心肌损伤标志物升高是手足口病患儿病情进展、预后评估的一项重要预警指标。伴有心肌损伤标志物、心肌酶学明显升高的手足口病患儿,更易出现顽固性休克、循环衰竭、甚至死亡。尤其是肌钙蛋白Ⅰ在正常值3倍以上者,应高度重视,及时救治。

Objective：To study the characteristics of myocardial injury of children with EV-71 infection severe HFMD（hand,foot and mouth disease）,especially in childen with neurogenic pulmonary edema. To explore the significance of myocardial injury markers in condition monitoring,prognosis evaluation of these childen. Methods：Doing a retrospective analysis of the clinical data of childen with HFMD at our hospital infection ward from 2012.5 to 2015.9. A total of 71 cases of children were included in the analysis,who confirmed by the municipal expert group of hand,foot and mouth disease.Who were positive for serum EV71-Ig M.It was divided into 3 groups：pulmonary edema group of 17 cases,brainstem encephalitis group of 21 cases in the same period,common viral encephalitis of 33 cases in the same period. The median age of cases was 1.80 years（range：5months to 7 years）,including 44 males and 27 females. The ratio of male to female was 1.63：1. Results：Compared pulmonary edema group with brainstem encephalitis group,the concentration values of myocardial injury markers was significantly different（P〈0.01）.Meantime,the concentration values of CKMB（creatine kinase MB）in pulmonary edema group was significantly higher than that in the brainstem encephalitis group,but the difference was not significant（P〉0.05）.Compared pulmonary edema group with common viral encephalitis group,and compared brainstem encephalitis group with common viral encephalitis group,the concentration values of myocardial injury markers and CKMB were all significantly different（P〈0.05）. There were 17 cases of death in 7 cases,give up treatment in 5 cases in pulmonary edema group.Meantime,there were 2 cases give up treatment in brainstem encephalitis group. There was a significant differences in mortality（χ^2 = 15.06,P value〈0.01）between the two groups.However,childen with common viral encephalitis had basically improved discharge after treatment.Compared pulmonary edema group with brainstem encephalitis group and common viral encephalitis group,the concentration values of myocardial injury markers were all significantly different（P〈0.05）.Who had the worst prognosis. Conclusions：Elevated myocardial injury markers was an important early warning indicators for the assessment of the disease progression and prognosis in children with HFMD.HFMD children accompanied by myocardial injury mark,myocardial enzyme increased significantly were more likely to have persistent shock,circulatory failure,and even death.Especially,we should attach great importance to children with troponin Ⅰin three times above normal,and timely take medical treatment.