摘要
目的比较评价感染性疾病患儿血清中肌酸激酶同工酶（creatine kinase,CK）-MB活性、CK-MB质量与肌钙蛋白（cardiac troponin I,c Tn I）的差别与临床价值。方法采用回顾性实验诊断研究。收集2014年1月至12月在第二军医大学附属长征医院和解放军第94医院急诊科、儿科门诊就诊的患感染性疾病患儿1 026例（包括89例临床诊断为病毒性心肌炎患儿）的入院血清标本1 026份;用免疫抑制法检测其CK-MB活性（采用临床正常参考值25 U/L或＆gt;46.8 U/L的异常率分别为60.4%（620/1 026例）和23.6%（242/1 026例）,检出c Tn I异常率为9.5%（97/1 026例）,2种正常参考值的CK-MB活性异常率高于c Tn I异常率（χ~2值分别为70.152、328.583,P值均=0.000）;而CK-MB质量检出的异常率为9.2%（94/1 026）,但与c Tn I的检出异常率的差异无统计学意义（9.5%,χ~2=991.068,P＆gt;0.05）。其中422例患儿在第一次检测的CK-MB活性和质量及c Tn I的四分位值分别为0.05μg/L、1.82μg/L、45.0 U/L,第一次检测后2至4 d第2次检测分别为0.05μg/L、1.82μg/L、25.5 U/L,首次检测与第2次检测的CK-MB活性和质量值比较,均下降（Z=-17.386,-7.399,P值均=0.000）,但2次c Tn I检测值间的差异无统计学意义（Z=-1.219,P=0.223）。结论 CK-MB质量与c Tn I异常的患儿数与临床诊断的病毒性心肌炎患儿例数接近,而CK-MB活性采用2种正常参考值的检测异常率偏高,CK-MB质量可作为未做c Tn I检测时的替代辅助诊断感染性疾病患儿心肌炎的指标。同时CK-MB活性和质量随患儿心肌损伤病情的好转,而降低的速度较c Tn I更快,因此比c Tn I更适合作为评价患儿心肌损伤病情变化或有无新发心肌损伤的敏感指标。
Objective To compare the application of serum creatine kinase（CK）-MB activity, CK-MB mass and cardiac troponin I（c Tn I） in 1 026 children who underwent infectiious disease using different cutoff value of CK-MB activity and common cutoff value of CK-MB mass and c Tn I. Observe the changing between three indices along with the improving of the infectious disease. Methods Retrospective study was used. Serum samples collected from 1 026 children with infectious disease were evaluated the CK-MB activity（cut off25 U/L and 46.8 U/L used by Cheng Soujin）, CK-MB mass and c Tn I using immunoinhibition method, electrical chemiluminescence immunoassayand automatic chemiluminescence immunoassay,respectively. Chi-square test and Wilcoxon signed rank test were used to compare the abnormal rate of these laboratory indexes in children with infectious diseases. Furthermore, Four hundred and twenty-two in 1 026 children were collected after administration（2-4 days） to observe the change of these laboratory indexes. Results The abnormal rates of CK-MB activity were 60.4%（25 U/L,620/1 026）, 23.6%（46.8 U/L,242/1 026）,respectively. The abnormal rates of CK-MB mass and c Tn I were 9.2%（94/1 026） and 9.5%（97/1 026）. A statistically significant difference was found in the abnormal rate of CK-MB activity（using two different cutoff values）and c Tn I（χ~2=70.152, 328.583, P=0.000）, but there were no significance of CK-MB mass and c Tn I using common cutoff value（χ~2=991.068, P=0.25）. Four hundred and twenty-two children were reinspected serum CK-MB activity, CK-MB mass and c Tn I in 2-4 days after the first tests. The level of CK-MB activity and CK-MB Mass were dropped significantly（Z=-17.386,-7.399,P=0.000）, but the level of c Tn I was not severely down（Z=-1.219,P=0.223）. Conclusions The number of patients with abnormal CK-MB and c Tn I is close to the clinical diagnosis of viral myocarditis, but the abnormal rate of CK-MB activity is higher than c Tn I. And CK-MB mass could be used as an alternative for c Tn I testing when the diagnosis of infectious diseases in children with myocarditis indicators. Meanwhile, CK-MB activity and CK-MB mass dropped faster than c Tn I when myocardial injury improvement of patients. Therefore, CK-MB activity and CK-MB mass are more suitable than c Tn I as a sensitive index for evaluating the changes of myocardial injury or new presence of myocardial injury in children.
出处
《中华临床实验室管理电子杂志》
2015年第2期113-117,共5页
Chinese Journal of Clinical Laboratory Management(Electronic Edition）
基金
南京军区科技创新重点课题资助项目(102016)
