晚发型母乳性黄疸对患儿心肌损害的临床研究

Clinical study on myocardial damage in children with late onset breast milk jaundice

目的 探讨晚发型母乳性黄疸对患儿心肌细胞影响及早期干预治疗的临床价值。方法 回顾复习本院儿科中心2020年4月至2022年1月收治的晚发型母乳性黄疸患儿86例病历资料,依据胆红素水平分别分为轻度组和中重度组。选取同期在本院儿童保健门诊查体足月健康新生儿60例为对照组。研究组患儿于入院当日黄疸高峰期、黄疸消退期留取静脉血2~3 mL检测血清总胆红素、心肌酶谱(CK、CK-MB)、肌钙蛋白I(cTnI);对照组常规检测上述项目,并对检测结果进行统计学分析。结果 在黄疸高峰期,中重度组心肌酶谱(CK、CK-MB)、cTnI水平较轻度组和对照组均有升高,差异均有统计学意义(P<0.05);轻度组心肌酶谱(CK、CK-MB)、cTnI水平与对照组比较差异无统计学意义(P>0.05)。在黄疸消退期,轻度组、中重度组心肌酶谱(CK、CK-MB)、cTnI水平与对照组比较差异均无统计学意义(P>0.05)。中重度组患儿黄疸高峰期,cTnI检出率为51.4%(18/35),明显高于CK、CK-MB检出率[17.1%(6/35),25.7%(9/35)],差异有统计学意义(P<0.05)。结论 检测血清心肌酶谱(CK、CK-MB)、cTnI能够及早发现晚发型母乳性黄疸患儿心肌损害情况,血清胆红素水平越高,心肌损害越严重,早期干预治疗有一定的临床价值。

Objective To explore the effect of late-onset breast milk jaundice on the myocardial cells of affected children and the clinical value of early intervention treatment.Methods A retrospective review of 86 cases of late-onset breast milk jaundice admitted to our Pediatric Center from April 2020 to January 2022 was conducted.According to the bilirubin level,they were divided into mild and moderate-severe groups.Sixty full-term healthy newborns examined in the Children's Health Clinic of our hospital during the same period were selected as the control group.On the day of admission,blood samples were collected from the study group during the peak and subsidence periods of jaundice,and 2 to 3 mL of venous blood was taken to detect serum total bilirubin,myocardial enzymes(CK,CK-MB),and cardiac troponin I(cTnI).The control group underwent routine testing of the above items,and the results were statistically analyzed.Results During the peak period of jaundice,the levels of myocardial enzymes(CK,CK-MB) and cTnI in the moderate-severe group were higher than those in the mild group and the control group,with statistically significant differences(P<0.05).There was no statistically significant difference in the levels of myocardial enzymes(CK,CK-MB) and cTnI between the mild group and the control group(P>0.05).During the subsidence period of jaundice,there was no statistically significant difference in the levels of myocardial enzymes(CK,CK-MB) and cTnI between the mild and moderate-severe groups and the control group(P>0.05).During the peak period of jaundice in the moderate-severe group,the detection rate of cTnI was 51.4%(18/35),which was significantly higher than the detection rates of CK and CK-MB[17.1%(6/35),25.7%(9/35)],with statistically significant differences(P<0.05).Conclusion Detecting serum myocardial enzymes(CK,CK-MB) and cTnI can early identify myocardial damage in children with late-onset breast milk jaundice.The higher the serum bilirubin level,the more severe the myocardial damage,indicating that early intervention and treatment has certain clinical value.