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目的探讨手足口病患儿心肌酶谱变化规律及其临床意义。方法收集南方医科大学珠江医院175例手足口病患儿双份血清及肛拭子标本。60例近期无特殊病史的体检儿童作为对照组,并收集其血清标本。肛拭子标本进行肠道病毒核酸检测,包括肠道病毒通用型、肠道病毒71型(EV71)及柯萨奇病毒A16型(CA16)。血清标本进行心肌酶谱检测,包括谷草转氨酶(AST)、α-羟丁酸脱氢酶(HBDH)、乳酸脱氢酶(LDH)、肌酸激酶同工酶(CK-MB)、肌酸激酶(CK)。结果 175例手足口病人肛拭子标本核酸检测,EV71阳性95例,CA16阳性34例,其它肠道病毒阳性46例。手足口病患儿组急性期心肌酶谱异常率高于正常对照组。心肌酶谱异常率最高的指标为LDH(84.57%),其后依次为CK-MB(62.29%)、CK(50.29%)、HBDH(43.43%)、AST(25.71%)。不同肠道病毒组急性期与恢复期不同心肌酶谱指标差异有统计学意义(P<0.05)。普通组与重症组比较,心肌酶谱各项指标差异均无统计学意义。结论心肌损伤为手足口病患儿较为常见的并发症,EV71感染较CA16感染更易引起心肌损伤。急性期心肌酶谱水平不能作为是否进展为重症手足口病的早期预警指标。
Objective To investigate the changes of myocardial enzymes in children with hand-foot-mouth disease and its clinical significance. Methods A total of 175 serum samples from two children with HFMD and anal swab in the Pearl River Hospital of Southern Medical University were collected. Sixty cases of children with no history of special medical examination were selected as the control group and their serum samples were collected. Rectal swab samples were tested for enterovirus nucleic acid, including enterovirus universal, enterovirus 71 (EV71), and coxsackie virus A16 (CA16). Serum samples were tested for myocardial enzymes, including AST, HBDH, LDH, CK-MB, creatine kinase (CK). Results 175 cases of hand, foot and mouth swab samples of human swabs nucleic acid test, EV71 positive 95 cases, CA16 positive in 34 cases, 46 cases of other enterovirus positive. Hand-foot-mouth disease in children with acute myocardial enzymes abnormal rate was higher than the normal control group. The index of abnormal myocardial enzymes was LDH (84.57%), followed by CK-MB (62.29%), CK (50.29%), HBDH (43.43%) and AST (25.71%). Different enterovirus in acute and convalescent different myocardial enzymes were significantly different (P <0.05). Compared with the severe group, there was no significant difference in the indexes of myocardial enzymes among the common group and the severe group. Conclusions Myocardial injury is a common complication in children with hand-foot-mouth disease. EV71 infection is more likely to cause myocardial damage than CA16 infection. Acute myocardial enzyme level can not be used as an early warning sign of severe HFMD.