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目的探讨联合检测心肌损伤标志物对心肌炎患儿心肌损伤的诊断价值。方法对64例病毒性心肌炎(VMC)患儿、56例非病毒性心肌炎(NVMC)患儿和52名健康对照儿童,分别检测2种心肌损伤标志物心肌肌钙蛋白I(cTnⅠ)、肌酸激酶同工酶(CK-MB)和5种心肌酶活性。结果检测cTnⅠ和CK-MB诊断心肌炎敏感性分别为71.88%和68.75%,差异无统计学意义(χ~2=0.15,P=0.70);特异性分别为96.30%和65.74%,差异有统计学意义(χ~2=32.78,P<0.001);准确性分别为87.21%和66.86%,差异有统计学意义(χ~2=20.13,P<0.001)。检测cTnⅠ和CK-MB对心肌炎诊断指数分别为0.68和0.34;阳性预告值分别为92.00%和54.32%,差异有统计学意义(χ~2=20.41,P<0.001);阴性预告值分别为85.25%和78.02%,差异无统计学意义(χ~2=1.86,P=0.17);联合检测cTnⅠ与CK-MB诊断心肌炎敏感性为84.38%、特异性为100%、准确性为94.19%、诊断指数为0.84、阳性预告值为93.10%、阴性预告值为91.22%。结论联合检测cTnⅠ与CK-MB诊断VMC的敏感性、特异性、准确性、阳性预告值与阴性预告值,均高于单一检测,对诊断病毒性心肌炎效果更好。
Objective To investigate the diagnostic value of combined detection of myocardial injury markers in myocardial injury in children with myocarditis. Methods Sixty-four children with viral myocarditis (VMC), 56 children with non-viral myocarditis (NVMC) and 52 healthy controls were enrolled in this study. Two cardiac injury markers, cardiac troponin I (cTnⅠ), creatine Kinase isoenzyme (CK-MB) and five kinds of myocardial enzyme activity. Results The sensitivity of detecting cTnI and CK-MB in diagnosing myocarditis were 71.88% and 68.75%, respectively, with no significant difference (χ ~ 2 = 0.15, P = 0.70); the specificity was 96.30% and 65.74% (Χ ~ 2 = 32.78, P <0.001). The accuracy was 87.21% and 66.86%, respectively. The difference was statistically significant (χ ~ 2 = 20.13, P <0.001). The diagnostic index of cTnⅠ and CK-MB in myocarditis were 0.68 and 0.34, respectively. The positive predictive values were 92.00% and 54.32% respectively, with significant difference (χ ~ 2 = 20.41, P <0.001) % And 78.02%, respectively (χ ~ 2 = 1.86, P = 0.17). The combined detection of cTnI and CK-MB was 84.38%, the specificity was 100% and the accuracy was 94.19% The index was 0.84, the positive predictive value was 93.10%, and the negative predictive value was 91.22%. Conclusions The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of combined detection of cTnI and CK-MB in diagnosis of VMC are higher than that of single detection and better in diagnosing viral myocarditis.