小儿手足口病合并心肌损害心肌酶CKMB检测及影响因素分析

Analysis of the level of myocardial enzyme CKMB and its influencing factors in children with hand,foot and mouth disease complicated with myocardial damage

目的:分析小儿手足口病合并心肌损害心肌酶肌酸激酶混合同工酶(CKMB)水平和异常率,探讨小儿手足口病合并心肌损害的影响因素。方法:选取100例手足口病患儿作为观察组(其中56例单纯手足口病患儿作为A组,44例合并心肌损害患儿作为B组),另选取50名同期体检的健康儿童作为对照组。比较A组和B组患儿治疗前后CKMB水平,并与对照组的CKMB水平进行比较。同时分析观察组患儿合并心肌损害与未合并心肌损害的一般资料和实验室指标,进一步对可能影响小儿手足口病合并心肌损害的相关因素进行logistic回归分析。结果:治疗前,观察组CKMB活性、CKMB异常率均高于对照组(P<0.01);观察组患儿治疗后的CKMB活性及异常率均较治疗前降低(P<0.01),治疗后2组的CKMB活性以及异常率的比较差异无统计学意义(P>0.05)。单因素分析结果显示B组患儿发热率、发热持续时间、CKMB、C反应蛋白(CRP)、白细胞(WBC)、中性粒细胞水平均高于A组患儿(P<0.05~P<0.01),而2组心率异常、血压异常、呼吸频次、皮疹部位、皮疹持续时间、淋巴细胞、红细胞、血红蛋白以及血小板水平差异均无统计学意义(P>0.05)。多因素logistic回归分析显示,发热、WBC、CRP以及CKMB水平均是导致心肌损害的危险因素。结论:对于手足口病患儿,CKMB升高提示合并心肌损害风险,临床中应加强手足口病患儿的心肌酶检测,并对检测结果异常患儿及早予以干预治疗;特别是对有发热症状以及WBC、CRP和CKMB水平升高者更需要进行有效控制,从而减少临床心肌损害的发生。

Objective:To analyze the level and abnormality rate of myocardial enzyme creatine kinase isozyme(CKMB)in children with hand,foot and mouth disease complicated with myocardial damage,and explore the influencing factors of children's hand,foot and mouth disease complicated with myocardial damage.Methods:A total of 100 children with hand,foot and mouth disease were set as the observation group,and 56 cases with hand,foot and mouth disease and 44 cases with hand,foot and mouth disease complicated with myocardial damage were subdivided into the group A and group B,respectively.Fifty healthy children in the same period were set as the control group.The levels of CKMB between before and after treatment in group A and group B were compared,and which was compared with the control group.At the same time,the general data and laboratory indexes in group A and group B were observed,and the related factors influencing the children with hand,foot and mouth disease complicated with myocardial damage were analyzed using multivariate logistic regression method.Results:Before treatment,the activity and abnormal rate of CKMB in observation group were significantly higher than those in control group(P<0.01),and the activity and abnormal rate of CKMB in observation group after treatment were significantly lower than those before treatment(P<0.01).After treatment,there was no statistical significance in the activity and abnormal rate of CKMB between the observation group and control group(P>0.05).The results of single factor analysis showed that the fever rate,duration of fever,and levels of CRP,WBC and CKMB in group A were higher than those in group B(P<0.05 to P<0.01),and there was no statistical significance in heart rate abnormality,blood pressure abnormality,respiratory frequency,rash site,duration of rash,and levels of lymphocyte,RBC,HBG and PLT between group A and group B(P>0.05).The results of multivariate logistic regression analysis showed that the fever,and levels of WBC,CRP and CKMB were the risk factors of myocardial damage.Conclusions:For children with hand,foot and mouth disease,the level of CKMB increasing hints the risk of myocardial injury.Strengthening the detection of myocardial enzymes in children with hand,foot and mouth disease,and early intervening the children with abnormal detection result,especially for the children with fever symptom,and levels of WBC,CRP and CKMB increasing,can more effectively prevent and reduce the occurrence of myocardial damage in clinic.