中枢神经系统感染血清心肌酶的变化及其临床意义

目的研究成年人中枢神经系统感染时血清心肌酶的变化及其临床意义。方法收集病毒性脑炎（病脑组）45例和结核性脑膜炎（结脑组）22例，另有体检正常者40例为对照组。采用东芝全自动生化分析仪，以酶速率法测定所有患者的血清天冬氨酸转氨酶（AST）、乳酸脱氢酶（LDH）、肌酸激酶（CK）、肌酸激酶心肌型同工酶（CK-MB）、α-羟丁酸脱氢酶（α-HBDH）水平。结果62.2％（28／45）病脑组血清心肌酶出现异常，与对照组比较差异有统计学意义（P〈0.01）；18.2％（4／22）结脑组血清心肌酶出现异常，与对照组比较，差异无统计学意义（P〉0.05）。病脑组患者血清中AST、LDH、CK水平及结脑组血清中AST、CK水平均明显高于对照组（P〈0.05或〈0.01），病脑组CK-MB、α-HBDH水平及结脑组LDH、CK-MB和α-HBDH水平与对照组比较，差异无统计学意义（P〉0.05）；结脑组CK水平明显低于病脑组（P〈0.05）。障碍组血清心肌酶水平均明显高于无障碍组（P〈0.05）。结论中枢神经系统感染常伴随心肌细胞损伤，血清心肌酶水平升高，对该类患者应常规行血清心肌酶测定。

Changes and clinical significance of serum myocardial enzymes in patients with central nervous system infection

Objective To explore the changes and clinical significance of serum myocardial enzymes in adult patients with central nervous system infection. Methods Forty-five patients suffering from virus encephalitis （virus encephalitis group） and 22 patients suffering from tuberculous meningitis （tuberculous meningitis group） were collected. Besides, 40 healthy subjects served as control group. Serum aspartate aminotransferase （AST）, lactate dehydrogenase （LDH）, creatine kinase （CK）, muscle heart-acid kinase isoenzyme （CK-MB）, α-hydroxybutyric acid dehydrogenase（α-HBDH） of the patients were examined by TOSHIBA automatic biochemical analyzer and enzyme rate assay. Results The myocardial enzyme level of 62.2% （28/45） of virus encephalitis group changed significantly compared with that of control group（P〈0.01） ;The myocardial enzyme level of 18.2 % （4/22） tuberculous meningitis group had no significant differences compared with that of control group （P〉0.05）. Serum AST,LDH,CK levels of virus encephalitis group and serum AST, CK in tuberculous meningitis group were significantly higher than those of control group（P〈0.05 or P〈0.01）. There were no significant differences in the levels of CK-MB, α-HBDH of tuberculous meningitis group and the levels of LDH,CK-MB and α-HBDH of virus encephalitis group compared with those of control group （P〉0.05） ;CK level of tuberculous meningitis group was significantly lower than that of virus encephalitis gorup（P 〈0.05）. The myocardial enzymes of patients with cerebral functional disorder were significantly higher than those of patients with normal cerebral function（P〈0.05）. Conclusion Central nervous system infection is associated with myocardial injury,increased serum myocardial enzyme level. So,those patients should be measured of their routinely myocardial enzymes in the serum.