联合检测h-FABP、Mb、cTnI和CK-MB在儿童手足口病合并心肌损伤早期诊断的临床价值

摘要

目的：探讨联合检测心型脂肪酸结合蛋白(h-FABP)、肌钙蛋白I(cTnI)、肌红蛋白(Mb)及肌酸激酶同工酶MB(CK-MB)在儿童手足口病(HFMD)合并心肌损伤早期的诊断价值。方法：选取在院就诊并确诊的276例HFMD患儿为观察组，同时选取40名健康儿童为对照组。分别测定不同时间患儿血清中h-FABP、cTnI、Mb和CK-MB含量，分析各组之间各指标水平的差异性及其含量在不同时间内的动态变化。结果：在观察组的276例HFMD患儿中诊断出HFMD合并心肌炎57例，占20.65%；在0～3 h内观察组的276例HFMD患儿血清中h-FABP、cTnI、Mb和CK-MB的异常率分别为20.29%、1.81%、14.86%和2.90%，h-FABP的异常率明显高于cTnI，两者比较有显著差异(x2=35.132，P＜0.01)；Mb的异常率明显高于CK-MB，两者比较有显著差异(x2=37.063，P＜0.01)；h-FABP异常率高于CK-MB，两者比较有显著差异(x2=3.175， P＜0.01)；HFDM合并心肌炎的57例患儿血清中h-FABP、cTnI、Mb和CK-MB浓度均明显高于对照组，各指标浓度之间差异均有统计学意义(t=37.625，t=23.172，t=17.261，t=18.724；P＜0.01)。在57例患儿血清中h-FABP和Mb浓度于HFMD合并心肌炎发生后0～3 h开始上升，4～9 h达到峰值；cTnI和CK-MB于4～9 h上升，10～12 h达到峰值，12～72 h内一直处于较高水平。结论：HFMD合并心肌炎有较高的发病率，h-FABP是早期诊断最敏感的指标，其次为Mb，cTnI和CK-MB是HFMD合并心肌炎中晚期诊断敏感指标。%Objective:To explore the early diagnostic value of joint detection heart type fatty acid binding protein (h-FABP), troponin (cTnI), myoglobin (Mb) and creatine kinase isoenzyme Mb (CK-Mb) in children's hand, foot and mouth disease (HFMD) combined myocardial injury.Methods: Choice 276 cases of HFMD as observation group, and 40 healthy children as control group. Were determined h-FABP, cTnI, Mb and CK-Mb content in serum at different time, analysis of various index level differences and dynamic change between groups in different period.Results: Among 276 patients with HFMD, 57 cases of diagnosed myocarditis, concurrent rate was 20.65%. Within 0~3 hrs, abnormal rate of h-FABP, cTnI, Mb and CK-Mb in serum were 20.29%,1.81%,14.86% and 2.90%, in 276 cases of children with HFMD. The abnormal rate of h-FABP and Mb was obviously higher than that of cTnI and CK-Mb, the results between the difference was statistically significant (x2=35.132,x2=37.063,P<0.01),h-FABP abnormal rate is higher than CK-Mb, the difference was statistically significant(x2=3.175,P<0.05). the,serum h-FABP cTnI, Mb and CK-Mb concentrations in children of HFDM combined with suspicious viral myocarditis were significantly higher than that of control group, the difference had statistical significance (t=37.625,t=23.172,t=17.261,t=18.724,P<0.01). H-FABP and Mb concentration on HFMD combined myocarditis began to rise after the occurrence of 0~3 h, 4~9 h to peak, CTnI and CK-MB 4~9 h to rise, 10~12 h to peak, has been in a higher level in the 12~72 h.Conclusion: HFMD combined myocarditis had a higher incidence, h-FABP is the most sensitive indicator of early diagnosis, followed by Mb. CTnI and CK-MB are parameters of diagnosis sensitivity for HFMD combined with myocarditis in middle-late period.