高敏肌钙蛋白T对儿童病毒性心肌炎诊断价值探讨

目的探讨高敏肌钙蛋白T(hs-cTnT)和肌酸激酶同工酶质量(CK-MB mass)对儿童病毒性心肌炎(VMC)的诊疗价值。方法选择VMC患儿67例,分别于患儿出现心累、气促等临床症状2~4 d以及治疗1周后检测血清hs-cTnT和CK-MB mass水平;同时测定54例急性胃肠炎患儿、53例上呼吸道感染患儿、50例肺炎患儿及55名健康体检儿童(正常对照组)的血清hs-cTnT和CK-MB mass水平并做比较。采用受试者工作特征(ROC)曲线评估hs-cTnT和CK-MB mass联合检测及单项检测时的敏感性和特异性。结果急性胃肠炎组、急性上呼吸道感染组、肺炎组、正常对照组及VMC组入院时的血清hs-cTnT水平中位数(四分位数)]分别为5.68(3.83,8.22)、5.03(3.00,6.57)、5.52(3.44,10.19)、4.81(3.22,6.67)和58.57(29.77,160.20)pg/mL;血清CK-MB mass水平中位数(四分位数)]分别为2.29(1.72,2.96)、2.26(1.41,3.48)、2.59(1.81,3.62)、1.83(1.42,3.05)和7.40(4.32,13.26)ng/mL;各组间hs-cTnT和CK-MB mass水平差异均有统计学意义(H值分别为115.15、83.79,P均0.001),且VMC组入院时hs-cTnT和CK-MB mass水平明显高于急性胃肠炎组、急性上呼吸道感染组、肺炎组和正常对照组(P均0.001)。VMC组治疗后hs-cTnT和CK-MB mass水平虽低于入院时(P均0.001),但仍高于急性胃肠炎组、急性上呼吸道感染组、肺炎组和正常对照组(P均0.001)。ROC曲线显示VMC入院时与治疗后hs-cTnT和CK-MB mass联合检测的敏感性高于单独检测hs-cTnT(P0.05),但特异性差异无统计学意义(P0.05)。结论 hs-cTnT用于诊断VMC有较高的敏感性和特异性,和CK-MB mass联合检测有更高的辅助诊断价值。

Significance investigation of high-sensitivity cardiac troponin T for viral myocarditis in children

Serum levels of hs-cTnT and CK-MB mass were determined in 67 patients with VMC （measured within clinical symptoms for 2- 4 d and after treatment for 1 week ）,54 children with acute gastroenteritis,53 children with acute upper respiratory tract infection,50 children with acute pneumonia and 55 healthy children （healthy control group）.The receiver operating characteristic （ROC ） curve was used to evaluate the sensitivity and specificity of hs-cTnT determination,CK-MB mass determination and the combined determination of hs-cTnT and CK-MB mass.Results Serum levels of hs-cTnT in acute gastroenteritis group,acute upper respiratory tract infection group,acute pneumonia group,healthy control group and VMC group median （quartile）]were 5.68（3.83,8.22）,5.03（3.00,6.57）, 5.52（3.44,10.19）,4.81（3.22,6.67）and 58.57（29.77,160.20）pg/mL,respectively,and serum levels of CK-MB mass median （quartile）]were 2.29（1 .72,2.96）,2.26（1 .41 ,3.48）,2.59（1 .81 ,3.62）,1 .83（1 .42, 3.05）and 7.40（4.32,1 3.26）ng/mL,respectively.There was statistical significance for hs-cTnT and CK-MB mass among the groups （H=1 1 5.1 5 and 83.79,P〈0.001 ）.Serum levels of hs-cTnT and CK-MB mass in VMC group after treatment were lower than those within clinical symptoms for 2-4 d （P〈0.001 ）,which were significantly higher than those in the acute gastroenteritis group,acute upper respiratory tract infection group,acute pneumonia group and healthy nbsp;control group （P〈0.001 ）.The ROC curve showed that the combined determination of hs-cTnT and CK-MB mass had higher sensitivity than hs-cTnT determination （P〈0.05）,but without significant specificity （P〉0.05）.Conclusions The hs-cTnT has high diagnosis sensitivity and specificity for VMC,and the combined determination of hs-cTnT and CK-MB mass has high diagnosis significance.