血清心脏肌钙蛋白I对小儿病毒性心肌炎诊断和转归监测价值

Evaluation of the Effect of Cardiac Troponin I on the Diagnosis and Progress of Viral Myocarditis in Children

摘要:

目的：评价心脏肌钙蛋白I(cTnI)对小儿病毒性心肌炎的诊断价值，探讨其与肌酸激酶同功酶(CK-MB)以及病毒性心肌炎的病程、病情演变等之间的关系。方法：采用免疫层析法和速率法测定38例病毒性心肌炎和24例非心肌炎患儿血清cTnI，CK-MB。间接ELISA法测定柯萨基病毒B1-6IgM(CVB1-6-IgM)。结果：病毒性心肌炎患儿血清cTnI和CK-MB阳性率分别为 89.5%，60.5%，明显高于非心肌炎组(8.3%，29.2%)和对照组(0)(P<0.05)。82.4% 的血清cTnI阳性出现在病程1周以内。CVB 1-6 IgM阳性与阴性组的cTnI和CK-MB阳性率差异无显著性。结论：血清cTnI反映心肌细胞损害的敏感性和特异性均高于CK-MB，有较宽的诊断时间窗，是一项极具临床价值的心肌炎诊断和转归监测新指标。

Abstract:

OBJECTIVE: To investigate the value of cardiac troponin I (cTnI) compared with creatine kinase isoenzymes (CK-MB) in the diagnosis and progress of myocarditis in children. METHODS: Serum samples from 38 children with viral myocarditis, 24 children with non myocarditis disease and 22 healthy controls were examined for cTnI by the rapid immunochromatographic test and CK-MB was examined by enzymatic velocity analysis. CVB1-6 IgM was determined using ELISA. RESULTS: The positive rates of cTnI and CK-MB in the myocarditis group were 89.5% and 60.5%, which were significantly higher than those in the nonmyocarditis group (8.3% and 29.2% respectively) and healthy control group (0) (P<0.05). 82.4% of positive cTnI occurred within one week of the onset. There were no differences in the positive rates of cTnI and CK-MB between the CVB1-6 IgM positive group and the negative one. CONCLUSIONS: The sensitivity and specificity of cTnI in the diagnosis of myocardial injury are superior to the CK-MB test and the diagnostic window of cTnI may be wider. cTnI appears to be an excellent new clinical marker for the diagnosis and the evaluation of prognosis of myocarditis.