心肌酶、电解质在小儿轮状病毒腹泻治疗及预后评估中的价值

The value of myocardial enzymes and electrolytes in the treatment and prognostic evaluation of rotavirus diarrhea in children

目的探讨心肌酶、电解质在小儿轮状病毒(RV)腹泻治疗及预后评估中的价值。方法选取安徽医科大学附属宿州医院儿童感染科2018年1月至2020年1月小儿RV腹泻90例,根据治疗7 d后预后分为治愈组(n=64)、未愈组(n=26)。比较两组基线资料、治疗前后心肌酶[肌酸肌酶(CK)、肌酸肌酶同工酶(CKMB)]、电解质指标水平,评价小儿RV腹泻预后的影响因素,分析心肌酶与电解质相关性及对患儿预后的评估价值。结果两组脱水程度、心肌损害、继发肠道细菌感染比较,差异有统计学意义(P<0.05);未愈组治疗1、3、7 d后CK、CKMB高于治愈组,血钠、血钾低于治愈组,差异有统计学意义(P<0.05);治疗7 d后CK、CKMB与血钠、血钾均呈负相关性(P<0.05);心肌损害、继发肠道细菌感染、治疗7 d后CK、CKMB、血钠、血钾是小儿RV腹泻预后的重要影响因素(P<0.05);治疗7 d后CK、CKMB、血钠、血钾联合评估小儿RV腹泻预后的曲线下面积(AUC)最大为0.921。结论心肌酶、电解质与小儿RV腹泻治疗效果相关,二者动态联合监测可为临床制定个性化治疗方案、评估预后提供循证支持。

Objective To investigate the value of myocardial enzymes and electrolytes in the treatment and prognosis evaluation of pediatric rotavirus(RV) diarrhea.Methods 90 children with RV diarrhea in Department of Pediatric Infection,Suzhou Hospital Affiliated to Anhui Medical University from January 2018 to January 2020 were selected and divided into cured group(n=64) and non cured group(n=26) according to the prognosis after 7 days of treatment.Compare the baseline data of the two groups,the levels of myocardial enzymes [creatine creatine enzyme(CK),creatine creatine enzyme isoenzyme(CKMB)],and electrolyte index levels before and after treatment,evaluate the factors affecting the prognosis of children with RV diarrhea,and analyze the correlation between myocardial enzymes and electrolytes and its evaluation value for the prognosis of children.Results There were significant differences in the degree of dehydration,the proportion of myocardial damage and the proportion of secondary intestinal bacterial infection between the two groups(P<0.05);CK and CKMB of the unhealed group were higher than the cured group after 1,3,and 7 days of treatment,and serum sodium and potassium were lower than the cured group(P<0.05);CK,CKMB and serum sodium,Serum potassium was negatively correlated(P<0.05);myocardial damage,secondary intestinal bacterial infection,CK,CKMB,serum sodium,and potassium after 7 days of treatment are important factors affecting the prognosis of children with RV diarrhea(P<0.05);The area under the curve(AUC) of CK,CKMB,serum sodium,and serum potassium combined to evaluate the prognosis of children with RV diarrhea was the largest after 7 days of treatment,which was 0.921.Conclusion Myocardial enzymes and electrolytes are related to the therapeutic effect of RV diarrhea in children,and the combined dynamic monitoring of the two can provide evidencebased support for clinical development of personalized treatment plans and prognosis assessment.