162例病毒性肠炎患儿肠外损伤及临床特征分析

Analysis of parenteral damages and clinical features of 162 children with viral enteritis

目的探讨诺如病毒和轮状病毒引起的病毒性肠炎患儿的肝功能、心肌酶的变化情况及其临床特征。方法选取2019年1月至12月昆明市儿童医院感染性疾病科收治的162例病毒性肠炎患儿为研究对象,其中诺如病毒组79例,轮状病毒组83例;另选取同期病毒检测阴性的81例肠炎患儿为对照组,比较患儿的肝功能和心肌酶及其临床特征。原始数据经Lg转换。结果(1)三组患儿肝功能的谷丙转氨酶(Lg-ALT)、谷草转氨酶(Lg-AST)比较,差异均有统计学意义(F值分别为11.394、21.222,均P<0.05)。(2)三组患儿心肌酶的肌酸激酶同工酶(Lg-CK-MB)、肌酸激酶(Lg-CK)、乳酸脱氢酶(Lg-LDH)、α-羟丁酸脱氢酶(Lg-α-HBDH)比较差异均有统计学意义(F值分别为45.855、9.100、4.586、9.237,均P<0.05)。(3)三组患儿的发热、呕吐、脱水、抽搐发生率比较差异均有统计学意义(χ^(2)值分别为6.697、35.987、18.212、15.484,均P<0.05)。(4)在患儿<1岁和2~岁阶段,诺如病毒组感染发生率与轮状病毒组比较差异均有统计学意义(χ^(2)值分别为10.334、27.477,均P<0.05)。结论轮状病毒相对诺如病毒更易引起心肌损伤,对病毒性腹泻肠炎应重视CK-MB的检测,根据发热与抽搐症状可进一步鉴别轮状病毒和诺如病毒性肠炎,对抽搐及腹泻患儿应重视诺如病毒的检测。

Objective To investigate changes in hepatic function and myocardial enzyme levels of children with noroviral and rotaviral enteritis,and their clinical features.Methods 162 children with viral enteritis who admitted to Department of Infectious Diseases of Kunming Municipal Children’s Hospital from January 2019 to December 2019 were selected as study subjects:79 cases in norovirus enteritis group,83 cases in rotavirus enteritis group.Other 81 patients with non-viral enteritis were included in the control group.The hepatic function,myocardial enzyme levels and clinical features of the children were compared.Results(1)In serum levels of Lg-ALT(ALT after Lg-conversion in variance analysis)and Lg-AST in hepatic function there were significant differences among the three groups(F=11.394 and 21.222 respectively,both P<0.05).(2)In serum levels of Lg-CK-MB,Lg-CK,Lg-LDH and Lg-α-HBDH in myocardial enzymes there were significant differences among the three groups(F=45.855,9.100,4.586 and 9.237 respectively,all P<0.05).(3)In incidences of fever,vomiting,dehydration and convulsions in the children among the three groups there were significant differences(χ^(2)=6.697,35.987,18.212 and 15.484 respectively,all P<0.05).(4)In the<1-year-old age subgroup and the 2~years-old age subgroup,there were significant differencs in infection incidences of the two viruses between the two groups(χ^(2)=10.334 and 27.477 respectively,both P<0.05).Conclusion Rotavirus is more prone to cause myocardial damage of the children than norovirus.For those children with diarrheal enteritis,CK-MB detection should be done.According to clinical symptoms such as fever and convulsions,rotaviral enteritis could be distinguished from noroviral enteritis.For those children with convulsions and infantile diarrhea,norovirus detection should be paid more attention.