对急性呼吸系统感染患儿血清CK-MB增高的再认识

摘要

目的　探讨急性呼吸系统感染患儿血清CK-MB增高而无心肌炎临床症状和心电图改变的原因。方法　对急性呼吸系感染患儿于病程的1～5天内采静脉血同时测定CK-MB(采用免疫抑制法)和CTnⅠ(采用夹心ELISA法)，并动态观察病人临床症状、心电图改变以判断是否合并心肌炎。结果　130例急性呼吸系感染患儿中血清CK-MB增高58例，血清CTnⅠ增高3例，其阳性率为100%，经卡方检验P<0.05，差异有显著性。127例临床无心肌炎的病例中，血清CK-MB增高55例，正常72例，127例患儿中血清CK-MB增高组、CK-MB正常组与正常儿童对照组三组间CTnⅠ值经方差分析P>0.05，差异无显著性。结论　应用免疫法测定的血清CK-MB值不能作为判断呼吸系感染时有无心肌损伤的“金指标”，应改用质量法测定血清CK-MB，或测定血清CTnⅠ来补充。%Objective　To study the cause of elevation of CK-MB in infants with withont acute respiratory system infection no symptoms of cardititis and abnormal ECG.Method　CK-MB and CTnⅠ were examined in the patients suffering from acute respiratory system infection within 1 tos days.Meanwhile,the clinical symptoms and ECG were dynamically observed in order to conclude whether they were associated with myocarditis.Results　130 cases were studied in which CK-MB elevated in 58 cases,CTnⅠ elevated in 3 cases,3 cases could be made definite diagnoses of myocardititis.The elevation of CTnⅠ was used to prediagnose the positive rate of myocarditis,up to 100 percent(P<0.05).In 127 cases without myocarditis,CK-MB elevated in 55 cases,and was normal in 72 cases.Conclusions　CK-MB examined by immunization is not a gold standard of cadiomyocyte injury during acute respiratory system infection.