传染性单核细胞增多症合并心肌损害患儿的临床症状、心肌酶谱及免疫功能特点分析

Analysis of clinical symptoms,myocardial enzyme and immune function characteristics in children with infectious mononucleosis and myocardial damage

目的探讨传染性单核细胞增多症(IM)合并心肌损害患儿的临床症状、心肌酶谱及免疫功能特点。方法回顾性分析2020年1月至2021年9月浙江省中西医结合医院儿科收治的154例IM患儿临床资料,按否合并心肌损害筛查病例,将IM患儿分为心肌损害组33例和无心肌损害组121例。分析对比两组患儿临床症状、心肌酶谱、免疫指标、肝功能及血常规指标。结果心肌损害组患儿胸闷胸痛(21.21%比7.44%,P<0.05)、心动过速(33.33%比6.61%,P<0.001)、心电图异常情况发生率[ST改变:27.27%比5.79%,P<0.001;T波改变:12.12%比0.83%,P<0.05;ST-T改变:12.12%比3.31%,P<0.05;窦性心律不齐:15.15%比1.65%,P<0.05]及肌酸激酶同工酶(CK-MB)[(35.60±10.84)U/L比(18.22±4.98)U/L,P<0.001]、乳酸脱氢酶(LDH)[(464.27±165.03)U/L比(407.12±128.82)U/L,P<0.05]、丙氨酸氨基转移酶(ALT)水平[(14.43±70.72)U/L比(95.67±35.09)U/L,P<0.05]均高于无心肌损害组。心肌损害组患儿血清免疫球蛋白A(IgA)、IgM水平及CD3^(+)、CD8^(+)比率均高于无心肌损害组[IgA:(1.93±1.16)g/L比(13.2±0.73)g/L,P<0.001;IgM:(2.21±1.34)g/L比(1.88±0.59)g/L,P<0.05;CD3^(+):(84.79±4.82)%比(81.97±6.50)%,P<0.05;CD8^(+):(53.70±13.40)%比(46.63±14.67)%,P<0.05],CD4^(+)/CD8^(+)低于无心肌损害组[(0.32±0.17)比(0.57±0.49),P<0.01]。结论IM合并心肌损害患儿具有胸闷胸痛、心动过速、心电图异常等临床表现,并且血清CK-MB、LDH、ALT、IgA、IgM水平及CD3^(+)、CD8^(+)比率升高,CD4^(+)/CD8^(+)降低。

Objective To investigate the clinical symptoms,myocardial enzyme,and immune function characteristics of children with infectious mononucleosis(IM)and myocardial damage.Methods This study retrospectively analyzed data on 154 IM children from Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine from January 2020 to September 2021.These children were divided into the myocardial damage group(n=33)and the non-myocardial damage group(n=121).Their clinical symptoms,myocardial enzyme profile,immune indexes,liver function,and routine blood indexes were collected and analyzed.Results In the myocardial damage group,incidence of the chest stuffiness and pain was 21.21%,tachycardia was 33.33%,and the ECG ST segment,T wave,and ST-T changes and sinus arrhythmia were 27.27%,12.12%,12.12%,and 15.15%,respectively.Levels of creatine kinase isoenzyme(CK-MB),lactate dehydrogenase(LDH),alanine aminotransferase(ALT),immunoglobulin A(IgA),and immunoglobulin M(IgM)were 35.60±10.84,464.27±165.03,and 114.43±70.72 U/L,and 1.93±1.16 and 2.21±1.34 g/L,respectively.The percentage of CD3^(+)and CD8^(+)T cells was 84.79±4.82 and 53.70±13.40%,respectively.The ratios of CD4^(+)/CD8^(+)T cells was 0.32±0.17.However,in the non-myocardial damage group,incidence of chest stuffiness and pain was 7.44%,tachycardia was 6.61%,the ECK ST segment,T wave,and ST-T changes and sinus arrhythmia were 5.79%,0.83%,3.31%,and 1.65%,respectively.Levels of CK-MB,LDH,ALT,IgA,and IgM were 18.22±4.98,407.12±128.82,95.67±35.09,1.32±0.73 and 1.88±0.59 g/L,respectively.Percentage of CD3^(+)and CD8^(+)T cells were 81.97±6.50%and 46.63±14.67%,respectively.The ratio of CD4^(+)/CD8^(+)T cells was 0.57±0.49.The data revealed that incidence of chest stuffiness and pain,tachycardia,abnormal ECG,and CK-MB,LDH,and ALT levels were higher in the myocardial damage group than those in the non-myocardial damage group(P<0.05).The IgA and IgM levels and percentage of CD3^(+)and CD8^(+)in the myocardial damage group were higher in the myocardial injury group than those in the non-myocardial injury group,whereas the ratio of CD4^(+)/CD8^(+)T cells was lower in the myocardial damage group than that in the non-myocardial injury group(P<0.05).Conclusion The IM children with myocardial damage showed chest distress,chest pain,tachycardia,abnormal electrocardiogram,and increased levels of CK-MB,LDH,ALT,IgA,IgM,and percentage of CD3^(+)and CD8^(+)T cells,but decreased the ratio of CD4^(+)/CD8^(+)T cells.