血清心脏肌钙蛋白I在儿童川崎病中的诊断价值

Clinical Assessment of Cardiac Troponin I in Children with Kawasaki Disease before and after the Treatment with Intravenous ImmunoglobulinsWU Rong

摘要:

目的：探讨静脉注射免疫球蛋白(IVIG)在川崎病(KD) 治疗前后血清心肌肌钙蛋白I(cTnI)浓度变化的临床意义。方法：检测 KD组 (n=58) 及对照组 (n=23) 患儿血清 cTnI、肌酸激酶(CK)、乳酸脱氢酶( LDH)与谷草转氨酶(GOT)的浓度。结果：KD组血清cTnI浓度为(0.62±1.08) μg/L，明显高于对照组(0.06±0.06) μg/L，两者差异有显著性意义(P<0.01)。KD组血清CK，LDH，GOT浓度分别为(122.48±37.65) IU/L，(178.56±68.73) IU/L和(30.49±13.52) IU/L，与对照组比较［(112.66±39.55) IU/L，(165.33±55.88) IU/L，(32.17±12.70) IU/L］差异无显著性意义(P>0.05)。IVIG治疗后cTnI浓度为(0.08±0.15) μg/L，明显低于治疗前(0.62±1.08) μg/L，差异有显著性意义(P<0.01)。IVIG治疗后血清CK，LDH，GOT浓度分别为(119.62±32.15) IU/L，(194.25±69.45) IU/L和(26.47±13.41) IU/L，与治疗前比较差异无显著性意义(P>0.05)。结论：cTnI是一项早期诊断 KD患儿急性心肌损伤的有价值的方法，可为早期静脉注射免疫球蛋白减少心血管病变提供依据，并可作为 IVIG疗效观察指标。

Abstract:

OBJECTIVE: To assess the clinical significance of the changes of cardiac troponin I (cTnl) in Kawasaki disease (KD) before and after the treatment with intravenous immunoglobulins (IVIG). METHODS: Concentrations of serum cTnl, Creatine kinase (CK), Lactic dehydrogenase (LDH) and Glutamic oxalacetic transaminase (GOT) were measured in the KD group (n=58) before and after the treatment with IVIG and in the control group (n=23). RESULTS: ① There was no significant difference in serum CK, LDH and GOT concentrations between the KD group and the control group (P>0.05). There was significant difference in the serum concentrations of cTnl between the two groups ［(0.62±1.08) μg/L vs (0.06±0.06) μg/L］( P<0.01). ② There was significant difference in cTnl before and after the treatment with IVIG ［(0.62±1.08) μg/L vs (0.08±0.15) μg/L］(P<0.01). But no significant difference was found in CK, LDH and GOT before and after the treatment with IVIG (P>0.05). CONCLUSIONS: The measurement of cTnl may be a useful serologic test for the early diagnosis of myocarditis or myocardial cell injury. Early IVIG therapy can prevent cardiovascular pathology in KD patients and cTnl can be used as an index to evaluate the effect of the treatment with IVIG.