轮状病毒感染性腹泻患儿血清肌酸激酶和肌酸激酶同工酶的水平变化及与脱水、酸中毒的相关性

Changes of the Levels of Serum Creatine Kinase and Creatine Kinase Isoenzyme and Its Correlation with Dehydration and Acidosis in Children with Rotavirus Infectious Diarrhoea

目的探讨小儿轮状病毒(RV)感染性腹泻血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)的水平变化,并分析其与脱水、酸中毒的关系。方法选取2019年1月至2020年12月南阳南石医院收治的240例RV感染性腹泻患儿作为阳性组,124例非RV感染性腹泻患儿作为阴性组。另选取68名同期于南阳南石医院接受健康体检的儿童作为对照组。按脱水程度将RV感染性腹泻患儿分为无脱水组、轻度脱水组、中度脱水组及重度脱水组。按酸中毒程度将RV感染性腹泻患儿分为无酸中毒组、轻度酸中毒组、中度酸中毒组、重度酸中毒组。分别测定患儿的CK、CK-MB水平。比较不同组间患儿的CK、CK-MB水平。分析CK、CK-MB水平与脱水、酸中毒的关系。结果在240例RV感染性腹泻患儿中,无脱水组、轻度脱水组、中度脱水组及重度脱水组患儿分别有23、156、50、11例,无酸中毒组、轻度酸中毒组、中度酸中毒组、重度酸中毒组患儿分别有26、166、42、6例。阳性组、阴性组和对照组CK、CK-MB水平比较,差异有统计学意义(P<0.05);阳性组CK、CK-MB水平高于阴性组和对照组,阴性组CK、CK-MB水平高于对照组(P<0.05)。无脱水组、轻度脱水组、中度脱水组及重度脱水组CK、CK-MB水平比较,差异有统计学意义(P<0.05);重度脱水组CK、CK-MB水平高于无脱水组、轻度脱水组和中度脱水组,中度脱水组CK、CK-MB水平高于无脱水组和轻度脱水组,轻度脱水组CK、CK-MB水平高于无脱水组(P<0.05)。无酸中毒组、轻度酸中毒组、中度酸中毒组、重度酸中毒组CK、CK-MB水平比较,差异有统计学意义(P<0.05);重度酸中毒组CK、CK-MB水平高于无酸中毒组、轻度酸中毒组和中度酸中毒组,中度酸中毒组CK、CK-MB水平高于无酸中毒组和轻度酸中毒组,轻度酸中毒组CK、CK-MB水平高于无酸中毒组(P<0.05)。CK、CK-MB水平与脱水程度均呈正相关(r=0.856、0.787,P<0.001)。CK、CK-MB水平与酸中毒程度均呈正相关(r=0.454、0.384,P<0.001)。结论RV感染性腹泻患儿的血清CK、CK-MB水平与脱水、酸中毒的关系显著,其水平可随着脱水和酸中毒程度的加深而升高。通过脱水、酸中毒程度可以预测RV感染性腹泻患儿的心肌损伤程度。

Objective To investigate the changes of the levels of serum creatine kinase(CK)and creatine kinase isoenzyme(CK-MB)in children with rotavirus(RV)infectious diarrhea,and to analyze its relationship with dehydration and acidosis.Methods From January 2019 to December 2020,240 children with RV infectious diarrhea were selected as positive group,and 124 children with non-RV infectious diarrhea were selected as negative group.Another 68 children who received physical examination in Nanyang Nanshi Hospital were selected as control group.According to the degree of dehydration,children with RV infectious diarrhea were divided into non-dehydration group,mild dehydration group,moderate dehydration group and hypertonic dehydration group.According to the degree of acidosis,children with RV infectious diarrhea were divided into non-acidosis group,mild acidosis group,moderate acidosis group and severe acidosis group.The levels of CK and CK-MB were measured respectively.The levels of CK and CK-MB of children in different groups were compared.The relationships between the levels of CK,CK-MB and dehydration or acidosis were analyzed.Results Among 240 children with RV infectious diarrhea,there were 23,156,50 and 11 cases in non-dehydration group,mild dehydration group,moderate dehydration group and hypertonic dehydration group respectively,and 26,166,42 and 6 cases in non-acidosis group,mild acidosis group,moderate acidosis group and severe acidosis group respectively.The levels of CK and CK-MB in positive group,negative group and control group were statistical different(P<0.05).The levels of CK and CK-MB in positive group were higher than those in negative group and control group,and the levels of CK and CK-MB in negative group were higher than those in control group(P<0.05).The levels of CK and CK-MB in non-dehydration group,mild dehydration group,moderate dehydration group and hypertonic dehydration group were statistical different(P<0.05).The levels of CK and CK-MB in hypertonic dehydration group were higher than those in non-dehydration group,mild dehydration group and moderate dehydration group,while those in moderate dehydration group were higher than those in non-dehydration group and mild dehydration group,and those in mild dehydration group were higher than those in non-dehydration group(P<0.05).The levels of CK and CK-MB in non-acidosis group,mild acidosis group,moderate acidosis group and severe acidosis group were statistical different(P<0.05).The levels of CK and CK-MB in severe acidosis group were higher than those in non-acidosis group,mild acidosis group and moderate acidosis group,while those in moderate acidosis group were higher than those in non-acidosis group and mild acidosis group,and those in mild acidosis group were higher than those in non-acidosis group(P<0.05).The levels of CK and CK-MB were positively correlated with the degree of dehydration(r=0.856,0.787,P<0.001).The levels of CK and CK-MB were positively correlated with the degree of acidosis(r=0.454,0.384,P<0.001).Conclusion The levels of serum CK and CK-MB in children with RV infectious diarrhea are significantly related to dehydration and acidosis,and their levels could increase with the deepening of dehydration and acidosis.The degree of myocardial injury in children with RV infectious diarrhea could be predicted by the degree of dehydration and acidosis.