血清肌钙蛋白Ⅰ升高在评价足月新生儿心肌损害中的意义

The Significance of Elevated Serum TroponinⅠin the Evaluation of Full-term Neonates with Myocardial Damage

目的探讨血清肌钙蛋白Ⅰ升高在评价足月新生儿心肌损害中的意义,为提高诊疗质量提供参考依据。方法选取2019年1月1日-2019年12月31日某院新生儿病房收治的入院24h内治疗前检测cTnⅠ水平>0.04ng/ml的足月新生儿,根据入院后24小时内治疗前及治疗7天后静脉血cTnⅠ变化分为cTnⅠ持续升高组(49例)、cTnⅠ降低组(44例),对2组患儿病因、感染相关指标、心肌损伤相关指标及相关影响指标进行综合分析。结果cTnⅠ持续升高组剖宫产率较高(P<0.05);2组围产期缺氧窒息史、性别及出生体重,差异无统计学意义(P>0.05)。cTnⅠ持续升高组新生儿败血症、新生儿高胆红素血症比率较高,差异具有统计学意义(P<0.05);cTnⅠ持续升高组新生儿治疗前降钙素原明显升高,差异具有统计学意义(P<0.05);2组在肌酸激酶、肌酸激酶同工酶MB及B型脑钠肽的差异均无统计学意义(P>0.05);cTnⅠ持续升高组患儿胸片提示心胸比值明显增大,心电图出现一过性窦性心动过缓、ST段改变、室上性心律失常及≥2种心律失常同时存在概率明显升高,超声心动图出现左心扩大概率明显升高,且差异均具有统计学意义(P<0.05)。49例cTnⅠ持续升高新生儿中,12例进行了心脏磁共振检查,均出现了不同程度的异常表现,包括心包积液7例、T2高信号4例、晚期延迟强化(LGE)2例、同时出现心包积液及LGE 1例。结论新生儿cTnⅠ升高尤其是治疗后持续升高提示新生儿心肌损害并持续存在,部分患儿心脏磁共振可见T2高信号及晚期延迟强化,病因以新生儿感染及高胆红素血症常见。

Objective To explore the significance of elevated serum troponinⅠ(cTnⅠ)in the evaluation of full-term neonates with myocardial damage.Methods Full-term newborns admitted to the neonatal ward of Beijing Anzhen Hospital Affiliated to Capital Medical University from January 1 st,2019 to December 31 st,2019 were selected,venous blood was collected within 24 hours after admission before treatment and 7 days after treatment and cTnⅠwas detected.According to the changes in the results,cTnⅠwas continuously increased(49 cases)and cTnⅠdecreased(44 cases),and etiology,infection-related indexes,myocardial injury related indexes and related influence indexes of the two groups were comprehensively analyzed.Results The cesarean section rate was higher in the cTnⅠcontinue increase group,and the differences were statistically significant(P<0.05).The perinatal history of asphyxia,gender and birth weight of the two groups showed no statistically significant difference(P>0.05).The rates of neonatal sepsis and neonatal hyperbilirubinemia were higher in the cTnⅠcontinue increase group.Neonatal asphyxia was not significantly different between the two groups(P>0.05).In the group with continuous increase of cTnⅠ,procalcitonin within 24 h after admission was significantly increased,and the differences were statistically significant(P<0.05).The differences of creatine kinase,creatine kinase isoenzyme MB,and B-type brain natriparin between the two groups were not statistically significant(P>0.05).The chest radiograph of children in the c TnI continue increase group showed a significant increase in the cardiothoracic ratio,transient sinus bradycardia,ST segment change,chamber on sex arrhythmia and cardiac arrhythmias exist in 2 or more in electrocardiogram(ECG)were probability significantly higher,and the probability of left heart enlargement on the echocardiography was significantly increased,and the differences were statistically significant(P<0.05).Among 49 neonates with continuously elevated cTnⅠ,12 were examined by cardiac magnetic resonance imaging(MRI),and all showed different degrees of abnormal manifestations,including pericardial effusion in 7 cases,T2 hypersignal in 4 cases,late delayed enhancement(LGE)in 2 cases,concurrent pericardial effusion and LGE in 1 case.Conclusions The increase of cTnⅠin neonates,especially the continuous increase after treatment,suggested the persistent myocardial damage in neonates.The cardiac magnetic resonance of some children could see T2 hypersignal and late delayed enhancement,which was commonly caused by neonatal infection and hyperbilirubinemia.